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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608323
Report Date: 08/13/2021
Date Signed: 08/13/2021 03:37:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2021 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210811101544
FACILITY NAME:MOUNTAIN VIEW TERRACE, LLCFACILITY NUMBER:
197608323
ADMINISTRATOR:LINDA MCINTOSHFACILITY TYPE:
740
ADDRESS:603 TOCINO DRIVETELEPHONE:
(626) 205-3211
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:6CENSUS: 4DATE:
08/13/2021
UNANNOUNCEDTIME BEGAN:
01:08 AM
MET WITH:Linda Mcintosh-Administrator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Unsafe transfer of residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted the initial 10 day complaint investivation. LPA met with Clara Mukutigwa (Caregiver) arrived during this visit. LPA explained the reason for today's visit. The administrator Linda Mcintosh arrived later and assisted with the visit.

The investiation consisted of the following: LPA interviewed administrator and three (3) staff (S1-S3) and four (4) residents (R1-R4). LPA obtained a copy of documents included: Staff and resident rosters and required employee documentation. LPA also toured the facility and no health and safety hazzards were observed.

The investigation revelaed of the following: LPA interviewed residents and all reported they all feel safe while staff transported them from bed to wheelchair. They never had any fall incidents while staff transferred them. LPA also interviewed staff and all stated that the facility has sufficient staffing and never witnessed any unsafe transfer for the residents. (Refer to LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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 28-AS-20210811101544
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: MOUNTAIN VIEW TERRACE, LLC
FACILITY NUMBER: 197608323
VISIT DATE: 08/13/2021
NARRATIVE
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Administrator reported all staff have to receive the "Stand Up lift/Patient Lift" machine training when they first hired. All staff also reported the Stand Up lift/Patient Lift machine only need one staff to operate the machine and it's user friendly and safe to transfer residents from bed to wheelchair or from bed to shower chair. In addition, Staff reported since they worked in the facility, no resident ever fell off by using the Stand Up Lift/Patient lift machine.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is UNSUBSTANTIATED.

Exit Interview conducted. A copy of the report and appeal right was provided to the administrator Linda Mcintosh.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
LIC9099 (FAS) - (06/04)
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