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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 12/11/2025
Date Signed: 12/11/2025 12:17:01 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
10/21/2024 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241021122200
FACILITY NAME:VISTA MONTANA SENIOR LIVINGFACILITY NUMBER:
336426330
ADMINISTRATOR:MARYANN KANEKOAFACILITY TYPE:
740
ADDRESS:155 N. GIRARD ST.TELEPHONE:
(951) 658-2274
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:120CENSUS: 84DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Maria Forkrud, AdministratorTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff are charging resident additional fees for food
Staff do not ensure that resident's personal information is kept confidential
Staff do not ensure that resident rooms are free of bugs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met with Maria Forkrud, Administrator, and informed them of purpose of the LPA's visit. The Department investigation involved interviews with staff, client, and a review of records.

On October 21, 2024, Community Care Licensing (The Department) received a complaint report with the following allegations.

It was alleged that staff are charging resident #1 (R1) additional fee for food. It was alleged that staff do not ensure that resident’s personal information is kept confidential. It was alleged that staff do not ensure resident rooms are free of bugs.

Continued on LIC9099-C.....
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 18-AS-20241021122200
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VISTA MONTANA SENIOR LIVING
FACILITY NUMBER: 336426330
VISIT DATE: 12/11/2025
NARRATIVE
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LPA Seo Jeon obtained resident and staff rosters and staff schedule from the administrator. LPA’s review of resident rosters revealed R1 lives in the independent part of this facility. It is an apartment building next to the assisted living facility. Independent living apartment is not within the Department's jurisdiction. LPA visited and conducted an interview with R1 and verified that R1 resides at independent part of the facility.

Based on records review and interviews, the above mentioned allegations were Unfounded. A finding of Unfounded means the allegation could not have happened, is false, and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2