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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:53:58 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
01/13/2026 and conducted by Evaluator Armando Perez
COMPLAINT CONTROL NUMBER: 18-AS-20260113222258
FACILITY NAME:VISTA MONTANA SENIOR LIVINGFACILITY NUMBER:
336426330
ADMINISTRATOR:MARIA FORKRUDFACILITY TYPE:
740
ADDRESS:155 N. GIRARD ST.TELEPHONE:
(951) 658-2274
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:120CENSUS: 84DATE:
01/26/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director Maria ForkrudTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff did not ensure that resident took medication as prescribed.
Staff did not address a change in resident's condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPAs), Armando Perez, Ahliah Sharp and Tremayne Barra conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA Perez met with Executive Director Maria Forkrud, where the LPA explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff and witnesses, and file reviews.

On January 13, 2026, Community Care Licensing Division (CCLD), received a complaint alleging that facility staff did not ensure that resident took medication as prescribed and staff did not address a change in resident's condition. Interview with Executive Director, Maria Forkrud, revealed that the name provided did not match any current or former residents. Interview with Staff 1 (S1) reviewed records and corroborated ED statements. LPA attempted to interview Additional Witness 1 (AW1), in order to obtain additional information; however, LPA was unable to obtain contact. Interview with Witness 2 provided the correct address, further revealing that the additional information does not align with the current facility.
Continued on LIC 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
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-20260113222258
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: 01/26/2026
NARRATIVE
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A review of facility records, including resident rosters, revealed no documented names matching the name reported.

Based on interviews, research, and record review, the allegation that facility staff did not ensure that resident took medication as prescribed and staff did not address a change in resident's condition is unfounded due to the listed resident not residing at the facility. A finding that the allegation is unfounded meaning that the allegation was false, could not have happened, and/or is without a reasonable basis. Therefore, this complaint is dismissed.

An exit interview was conducted. A copy of this report was provided to Executive Director Maria Forkrud.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2