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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 12/12/2025
Date Signed: 12/12/2025 09:36:39 AM

Unsubstantiated


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
07/11/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20240711152741
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:
12/12/2025
UNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Maria ForkrudTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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Staff financiallly abused resident in care.
INVESTIGATION FINDINGS:
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On December 11, 2025, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent visit to deliver findings regarding the above allegation. LPA Richard met with the Administrator Maria Forkrud (A1), and the purpose of the complaint was explained. LPA and the Administrator toured the facility.

The investigation consisted of the following: On July 15, 2024, Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to initiate an investigation into the allegation listed above. On December 11, 2025, Licensing Program Analyst (LPA) Antonine Richard reviewed and obtained the following documents: the Resident Roster (dated12/10/25), the Staff Roster (dated12/02/25), the Admission Agreements (dated 08/25/20) for Residents #1 (R1), and the Personal & Incidental (P&I) funds records (dated 06/16/25, 12/01/25) for Residents #1. Physician Report (dated 03/18/25), for (R1). Facility ledger for R1 (dated 10/31/23, 03/01/24 and 6/04/24). LPA Richard also conducted interviews with six residents (R1-R6), five staff members (S1-S5), and the administrator (A1).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2025
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-20240711152741
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: 12/12/2025
NARRATIVE
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Allegation: Staff financially abused resident in care.

The complaint alleged that a resident closed the bank account on 07/11/24 due to unauthorized charges and concerns about account activity, which resulted in a low balance. On December 11, 2025, the LPA interviewed the Administrator (A1), who stated that this happened under a former Administrator (A1) when the incident was brought to the facility's attention, and the facility took action. A1 is no longer employed here. On December 11, 2025, the LPA also interviewed five staff members (S1-S5), who stated that they were informed about the incident and had never accessed any of the residents' bank accounts. Additionally, on December 11, 2025, the LPA interviewed Resident #1 (R1), who stated that R1 believed the case was closed because no one had access to R1's bank account and R1 didn’t want to discuss it. R1 stated that the bank account was closed, and R1 is the only one with access to R1's money. The matter is now closed. LPA interviewed five residents (R2-R6). 3 out of 5 stated they have no problems with their P&I money. On December 11, 2025, during the review of the facility ledger records and bank statements, the LPA observed that some unauthorized charges bore R1's signature.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur; therefore, the allegation is unsubstantiated.

Exit interview conducted with Administrator Maria Forkrud, and a copy of this report was provided.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

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

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