<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881251
Report Date: 05/29/2025
Date Signed: 05/29/2025 03:09:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/27/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250527124010
FACILITY NAME:WESTHILLS VILLA GARDENSFACILITY NUMBER:
331881251
ADMINISTRATOR:THELMA MONTEBONFACILITY TYPE:
740
ADDRESS:5466 WEST WILSON ST.TELEPHONE:
(951) 849-7521
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:30CENSUS: 21DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Administrator Thelma MontebonTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff caused multiple injuries to residents in care.
Facility staff left resident soiled for an extended period of time.
Facility staff do not provide activities for residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPAs met with Administrator Thelma Montebon and discussed the purpose of the visit.

Regarding Allegation #1, Based on observations and interviews with staff and residents, it was alleged that Resident 1 (R1) sustained multiple injuries by staff. LPAs did not observe injuries on R1 nor other residents in care, however Staff (S1) explained R1 recently sustained a cut on their leg due to their wheelchair. LPAs conducted 6 resident interviews, which all denied sustaining injuries from staff while in care. LPAs conducted 3 staff interviews all which denied handling residents in a rough manner causing any injuries to residents.

Regarding Allegation #2, LPAs conducted 6 resident interviews, 4 out of 6 residents stated they do not wear diapers, 2 out of 6 residents stated they do wear diapers; however they are able to change their own diapers, but staff assist when needed. LPAs conducted 3 staff interviews all which denied leaving residents in soiled diapers for a long period of time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20250527124010
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WESTHILLS VILLA GARDENS
FACILITY NUMBER: 331881251
VISIT DATE: 05/29/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding Allegation #3, LPAs observed an activities calendar posted in the dining room. LPAs observed most of the residents were in the living room watching tv. Based on interviews most residents like to participate in their own activities, however staff encourage them to exercise and walk around.

Based on observation, interviews, and pertinent documents the allegations are unsubstantiated. An Unsubstantiated complaint means, that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted with Administrator Thelma Montebon and a copy of this report was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2