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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 11/03/2021
Date Signed: 11/03/2021 04:58:29 PM

Substantiated


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
12/16/2020 and conducted by Evaluator Linda M Almaraz
COMPLAINT CONTROL NUMBER: 28-AS-20201216144646
FACILITY NAME:MOUNTAIN VIEW CENTERFACILITY NUMBER:
197801605
ADMINISTRATOR:LAURA HERNANDEZFACILITY TYPE:
740
ADDRESS:715 WEST BASELINE ROADTELEPHONE:
(909) 626-6633
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:40CENSUS: 10DATE:
11/03/2021
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Assistant Administrator, Laura HernandezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Resident was sexually assaulted while in care
Resident was exposed to scabies while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA's) Jewel Baptiste and Linda Almaraz conducted a subsequent visit to investigate and deliver findings for the allegations listed above. Allegation #1 was referred to the Investigation Bureau and was investigated by Investigator Brian Slatic. LPA's met with Assistant Administrator, Laura Hernandez and explained the reason for todays visit. On todays visit LPA's conducted additional file review and collected documents for Residents.

The investigation consisted of the following: On 12/23/2020, LPA Linda Almaraz and Kruz Long conducted a virtual tour of the living and dining area, kitchen, outside patio, common areas and resident rooms and bathrooms. The kitchen was clean and had sufficient perishable and non-perishable food. Resident rooms and common areas were properly furnished. Bathrooms were operable. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA Almaraz interviewed Administrator Trupti Mody, Licensee Smita Sanghvi and Staff #1-3. LPA requested copies of staff and resident rosters along with Residents #1-5 file to be emailed by 12/23/2020 to LPA Almaraz. (Conitnued on an LIC 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Linda M Almaraz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 3
Control Number 28-AS-20201216144646
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 CENTER
FACILITY NUMBER: 197801605
VISIT DATE: 11/03/2021
NARRATIVE
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LPA interviewed current and former staff #1-15 and #17-18 along with Witness #19 telephonically on the following dates; 12/29/2020, 2/9/2021, 2/11/21, 2/12/21, 3/16/21, 3/23/21, 4/6/21 and 4/16/21. On 11/2/2021, LPA's requested copies of additional residents records.

Investigator Brian Slatic conducted interviews with current and former staff, family members, and residents in regards to allegation #1. The investigator also obtained records for residents.

The investigation revealed the following: In regards to allegation, "Resident was sexually assaulted while in care ," During the course of the investigation, the investigator obtained information from individuals who personally witnessed many of the alleged actions and behaviors of Resident #9. Former staff members report seeing Resident #9 touch, fondle and rub female clients on their breasts and vaginal areas. Resident #9 was found in another residents room, while the other resident had their pants down. Resident #9 was found in the bed of a female resident and caught taking a female dementia resident to the back area of the facility. Resident #9 also attempted to sexually assault a female resident while under the influence of drugs. Multiple staff informed Staff #1, the Administrator at the time of the incidents. However, no substantive action appeared to have been taken to stop the behaviors and residents continued to be victimized by Resident #9. There is no information or evidence that any of these incidents were reported to Community Care Licensing (CCL) or other agencies.

In regards to allegation, "Resident was exposed to scabies while in care" it was alleged a few residents had scabies at the facility. It was also alleged staff was not notified or given proper instructions on handling contagious residents. Records reviewed revealed Resident #8 was diagnosed with scabies on 8/25/2020, Resident #6 on 8/27/2020 and Resident #13 sometime later that year. Interviews with staff revealed that they were never trained on how to handle residents with scabies. Staff #1, who was the administrator at the time stated that Resident #6 and #8 did in fact have scabies. Per staff #1 both residents were room mates. Interviews with staff stated that Resident #8 had scabies first and later gave it to Resident #6. Per Staff #1, hospice said it was not scabies and later determined that it was. It was never reported to CCL. Staff #1 stated the Licensee, staff and families were notified. LPA received documents on todays visit from the County of Los Angeles Public Health being notified and a case being opened.

Based on records reviewed, evidence, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiencies cited under California Code of Regulations Title 22. Immediate civil penalties of $500 is being issued.

At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49 (f) For a violation that the department determines constitutes physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, or resulted in serious bodily injury, as defined in Section 15610.67 of the Welfare and Institutions Code, to a resident, the civil penalty shall be ten thousand dollars ($10,000).

An exit interview was conducted with Assistant Administrator, Laura Hernandez and caregiver Elvira Cortez, hard copy of this report was provided along with appeal rights.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Linda M Almaraz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20201216144646
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 CENTER
FACILITY NUMBER: 197801605
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2021
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature......
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Administrator will ensure all residents are free from any type of abuse from staff or other residents. Administrator will create a plan outlining the steps taken when they are notified by staff or persons about possible abuse. Plan will be submitted to LPA via fax only by POC due date.
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This requirement was not met as evidence by: The Administrator was notified and aware about the sexual abuse Resident #9 was doing to other residents and did not take action to mitigate the abuse.
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Request Denied
Type B
11/10/2021
Section Cited
CCR
87211(a)(1)(D)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1)A written report shall be submitted to the licensing agency.....(D) Any incident which threatens the welfare, safety or health of any resident..... .
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Administrator will ensure to report any cases of contagious diseases/infections to CCL immediatelty and provide all cross reporting information made to other agencies. Administrator will submit a plan stating what actions/steps will be taken when there is a case in the facility via fax by POC due date.
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This requirement was not met as by evidence:
The facility had (3) residents diagnoses with scabies and did not report it to CCL. A case was open with the County of Los Angeles public health and CCL was not notified.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Linda M Almaraz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3