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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 04/19/2022
Date Signed: 04/19/2022 11:42:03 AM

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
12/15/2020 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201215092514
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: 18DATE:
04/19/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Elvira Cortez (Activity Director)TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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1: Resident was sexually assaulted by another residents in care.
2: Resident was exposed to scabies.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kruz Long and Ashley Calderon conducted an unannounced subsequent complaint visit to deliver complaint findings for the above allegations. Upon arrival, LPAs met with Elvira Cortez (Activity Director) and discussed the purpose of the visit.

During the initial complaint investigation conducted on 12/23/20, LPA’s Kruz Long and Linda Almaraz conducted a health and safety check and requested a copy of the Staff and Resident roster. LPAs also toured the facility via Facetime with Smita Sanghvi and observed that the facility is clean and in good repair. There are nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Wash basins, showers/bathtubs and toilets are operable. There are no immediate health and safety concerns during today's investigation.

Per cross compliant investigation #28-AS-20201216144646, LPA Almaraz interviewed current and former staff along with a witness #1 (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 Almaraz requested copies of additional resident’s records. Continue to LIC9099C.....
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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-20201215092514
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: 04/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/20/2022
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......
This requirement was not met as evidence by:
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Administrator to provide a letter from licensee indicating licensee has read and will comply with section 87468.1 (a) (3). Administrator will create a plan outlining the steps taken when they are notified by staff or persons about possible abuse by POC due date.
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The investigation revealed information from staff #24 and resident's family who personally witnessed many of the actions and behaviors of resident #7. Former staff members reported seeing resident #7 touch, fondle and rub female residents on their breasts and vaginal area. Resident #7 was found in another resident's room while resident #7 pants were down and resident #7 was also found in the bed of a female resident and was caught taking a female dementia resident to the back area of the facility. Resident #7 also attempted to sexually assault a female resident while under the influence of a substance. Despite, staff #24 being aware of resident #7 inappropriate sexual actions and behaviors with facility residents, no substantive action was taken by staff #24 to stop resident #7 behaviors and facility residents continued to be victimized by resident #7.
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Type B
05/03/2022
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement is not met as evidenced by:
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Cleared during visit. Administrator provided a copy of Los Angeles County Public Health’s clearance letter dated 05/14/21, which indicate the facility was cleared of scabies outbreak.
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Interviews with staff stated that Resident #9 had scabies first and later gave it to Resident #3. Per staff #24, hospice agency said it was not scabies and later determined that it was. The facility did not report scabies to Community Care Licensing. former administrator stated the Licensee, staff and families were notified of the outbreak. During the 04/13/21 site visit, LPA Almaraz received documents indicating that the Los Angeles County Public Health was being notified and a case was being opened.
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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: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20201215092514
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: 04/19/2022
NARRATIVE
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In regards to the allegation: “Resident was sexually assaulted by another residents in care”. The department interviewed administrator, current and staff #24, resident #1 to #6, witnesses and resident family members, review client records and Los Angeles County Sheriff's Department report #020-06398-0878-444. The investigation revealed information from staff #24 and resident's family who personally witnessed many of the actions and behaviors of resident #7. Former staff members reported seeing resident #7 touch, fondle and rub female residents on their breasts and vaginal area. Resident #7 was found in another resident's room while resident #7 pants were down and resident #7 was also found in the bed of a female resident and was caught taking a female dementia resident to the back area of the facility. Resident #7 also attempted to sexually assault a female resident while under the influence of a substance. Despite, staff #24 being aware of resident #7 inappropriate sexual actions and behaviors with facility residents, no substantive action was taken by staff #24 to stop resident #7 behaviors and facility residents continued to be victimized by resident #7.

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 #9 was diagnosed with scabies on 8/25/2020 and Resident #10 on 09/21/20. Interviews with staff revealed that they were never trained on how to handle residents with scabies. Staff #24, who worked as the former administrator stated that Resident #3 and Resident #8 did in fact have scabies. Per Staff #24, both residents were roommates.

Interviews with staff stated that Resident #9 had scabies first and later gave it to Resident #3. Per staff #24, hospice agency said it was not scabies and later determined that it was. The facility did not report scabies to Community Care Licensing. former administrator stated the Licensee, staff and families were notified of the outbreak. During the 04/13/21 site visit, LPA Almaraz received documents indicating that the Los Angeles County Public Health was being notified and a case was 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 with appeal rights.

"The licensee was informed that a civil penalty might be assessed based on health and safety code 1569.49 (e)or (f), or 1548 (e) or (f), 1568.0822(e) or (f)."

Exit interview conducted with Elvira Cortez (Activity Director)and a copy of this report and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3