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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 08/16/2022
Date Signed: 08/23/2022 10:17:42 AM

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
09/14/2021 and conducted by Evaluator Elizabeth Ceniceros
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210914163636
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: 24DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Laura HernandezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Resident sustained scabies while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Staff #1 (S1: Daisy Fritter, Receptionish). LPA/RA spoke to Asst. Administrator (A2: Elvira Cortez) upon entering the facility to conduct a risk assessment. A2 informed LPA that the facility has no "new" COVID cases nor do any of the residents or staff have symptoms. The purpose for today's visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegation. The initial 10-Day visit was conducted by LPA Joe Katrdzhyan on 09/21/21 who met with (then) Staff #1 (S1: Activities Director, Elvira Cortez); as Administrator (A1: Laura Hernandez) was unavailable at the time of this visit.

LPA/RA Ceniceros interviewed Administrator and (5) facility staff members and did not interview Resident #1 who moved and (0) residents due to their cognitive impairment (approx.) 1:15 pm - 2:15 pm. LPA/RA Ceniceros reviewed documentation (Admission Agreement, Emergency I.D. and Information, Physician's Report, Appraisal/Needs and Services Plan, Incident Reports, Facility Progress Notes, MAR, Referral/Order Requisition, and Physician's Medication Order) for Resident #1 (from 2:15 pm - 3:00 pm).
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Araceli Ramirez
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Ceniceros
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
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 2
Control Number 28-AS-20210914163636
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: 08/16/2022
NARRATIVE
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Regarding Allegation #1: this investigation revealed that Resident #1 moved into the facility on 01/28/20. On 02/13/20, facility staff notified the resident's doctor to advise of a rash on the resident's inner side of both arms that the resident was complaining of itchiness. On 04/14/20, a call was placed to the resident's doctor to let him know of the rash to the resident's left arm; and, staff was given a video call appointment for 04/15/20 at 2:30 p.m. and a physician's order for medication (hydrocortisone cream) was prescribed for atopic dermatitis. On 08/07/20, Resident #1 received the referral for a dermatologist. On 08/25/20, Resident #1's Responsible Person took the resident for its dermatology appointment and Resident #1 was diagnosed with papular dermatitis and possible eczema on upper trunk and worsening on hands. Resident #1 was prescribed medications (Ivermectin and Elimite cream) to apply cream and take pill once and repeat in one (1) week. On 09/17/20 a second call was placed to Resident #1's Dermatologist (Dr. David Thomas Robles, M.D., PhD) to request a second treatment for the scabies. Based on interviews conducted of facility staff, the majority indicated that there were no reports of staff members or residents diagnosed with scabies (between 01/28/20 - 09/22/20); therefore, when Resident #1 was admitted to the facility, the resident already showed signs of atopic dermatitis and later diagnosed with scabies on 08/25/20.

Based on the evidence gathered and interviews conducted and records reviewed, 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 allegation of NEGLECT/LACK OF CARE: Resident sustained scabies while in care is found to be UNSUBSTANTIATED.

An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator (Laura Hernandez).

NAME OF LICENSING PROGRAM MANAGER: Araceli Ramirez
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Ceniceros
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2