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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426330
Report Date: 04/06/2026
Date Signed: 04/06/2026 01:09:18 PM

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
09/06/2024 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240906104031
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: 81DATE:
04/06/2026
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Maria Forkrud, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not prevent resident from being assaulted by other resident while in care
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 allegation. LPA met with Maria Forkrud, Administrator and informed them of the purpose of the visit. The Department's investigation involved interviews with staff and resident and review of records.

On September 6, 2024, Community Care Licensing Division (The Department) received a complaint report with the following allegation.

It was alleged that staff did not prevent resident from being assaulted by other resident while in care. Information received indicated that staff did not prevent Resident #1 (R1) from being assaulted by another resident. The Department's records review revealed the following:

On September 5, 2024, R1 was observed and examined at Riverside University Health System Medical Center following the alleged incident. Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 18-AS-20240906104031
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: 04/06/2026
NARRATIVE
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During the evaluation, R1 provided limited history and did not answer questions asked by the examiner, often discussing unrelated topics. R1 frequently fell asleep and was not easily awakened. R1 fell asleep multiple times during the interview and exam. R1 was allowed to sleep, and the examining nurse returned to R1 multiple times to complete the interview and exam. The forensic exam concluded when R1 declined to proceed with any additional medical exam. The evaluation did not reveal any conclusive findings.

The Department conducted an interview with R1 who stated that R1 was never assaulted by Suspected Abuser (SA), adding that SA was R1's friend and admitted the allegation was false. R1 stated that R1 submitted a signed handwritten statement to the Administrator, recanting R1’s previous claims and allegations.

Maria Forkrud, the Administrator, stated an internal facility investigation was conducted, and staff attempted to interview R1’s roommate, Resident #2 (R2). Due to R2’s health condition, R2 was unable to provide any detailed information about the alleged incident. On September 12, 2024, the Administrator stated that R1 gave a statement recanting R1's allegations against SA and contacted Hemet Police Department and retracted R1's statement previously made to the police. R1 wrote a written statement to the police that the alleged incident never occurred. The Administrator stated that R1 and SA are currently seeing each other as friends.

Based on interviews conducted and records review, the Department's investigation did not provide enough information to corroborate the allegation that staff did not prevent resident from being assaulted by other resident while in care. This allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.



An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
LIC9099 (FAS) - (06/04)
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