197801605-11-14-2022-28-AS-MVAO-CMHS6C-20221227123545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 11/14/2022
Date Signed: 11/14/2022 10:21:19 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
12/11/2020 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20201211182520

FACILITY NAME:	MOUNTAIN VIEW CENTER		FACILITY NUMBER:	197801605
ADMINISTRATOR:	LAURA HERNANDEZ		FACILITY TYPE:	740
ADDRESS:	715 WEST BASELINE ROAD		TELEPHONE:	(909) 626-6633
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	40	CENSUS: 30	DATE:	11/14/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator Lauria Hernandez		TIME COMPLETED:	10:36 AM

ALLEGATION(S):

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Staff hit residents in care.
Staff yell at residents in care.
Staff speak inappropriately to residents in care.
Staff force feed residents in care.
Staff rough handle residents in care.

INVESTIGATION FINDINGS:

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On 11/14/2022 at 9:50 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to deliver findings on the allegations listed above. The initial complaint visit was conducted by LPA Wesley on 12/18/20. LPA also conducted a subsequent complaint on 10/20/22. LPA met with Laura Hernandez and explained the reason for the visit.

During the initial visit LPA Wesley conducted a telephonic interview and requested copy of: staff roster, resident roster, and current staff training documents included but not limited to Personal rights(resident's), Care for persons with Dementia, and Food service by Monday, December 21, 2020.

Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

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-20201211182520

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: 11/14/2022

NARRATIVE

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During the subsequent complaint visit, LPA Baptiste toured the facility and observed the resident’s lunch hour. LPA obtained resident roster, staff roster, staff training on resident’s personal rights, Resident #1(R1) physician’s report, R1’s new admit requirements, R1’s hospice information, R1’s personal rights dated 7/20/2020, R1’s physician consultation final report dated 1/16/2018, R1’s Identification and Emergency information, Resident #2 (R2) Hospice information, R2’s personal right’s, R2’s physician report, and R2’s Identification and emergency information. LPA interviewed Residents R3 through R7. LPA also interviewed administrator and Staff S3 through S6.

Prior to returning to the facility LPA interviewed Family Members (FM) for resident R1 (FM1) and R2(FM2). LPA interviewed Former staff S6. LPA attempted to interview former staff S2, S7, S8, S9, S10 and S11. LPA interviewed current staff S1.

The investigation reveals the following: Regarding "Staff hit residents in care", it is alleged that S1 hit R1. The Administrator and Current Staff interviewed denied the allegation. They stated that staff do not use physical force on the residents and have never witnessed staff hitting a resident. FM1 stated that they have never witnessed S1 hit R1 but have witnessed unexplained bruises on R1 during visitations. FM2 stated they have never witnessed staff hit residents nor has R2 complained about being hit by staff while living at the facility. S6 stated they did not witness staff hit residents.

The investigation reveals the following: Regarding " Staff yell at residents in care.", it is alleged that S1 yells at the residents in care. The Administrator and Current Staff denied the allegation. 5/5 residents indicated that staff has not yelled at them at the facility. FM1 stated that they have witnessed a staff yelling at a resident during a visit but cannot recall which resident or staff was involved. FM2 stated that R2 complained that former staff S11 yell at R2. FM2 stated that S11 was confronted and did not deny the allegation. S6 stated that they did not witness S1 yelling at residents.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20201211182520

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: 11/14/2022

NARRATIVE

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The investigation reveals the following: Regarding "Staff speaks inappropriately to residents in care", it is alleged that S1 called R2 a “bitch” making R2 cry. The Administrator and Current Staff denied the allegation. 5/5 residents indicated that staff has not spoken to them inappropriately. FM1 stated that they have witnessed a staff yell at a resident during a visit but cannot recall which resident or staff was involved. FM2 stated that a former staff (S3) informed FM2 that the staff was yelling at R2 and made R2 cry. S6 stated that they have witnessed S1 and another staff teasing a resident about a deceased loved one.

The investigation reveals the following: Regarding "Staff force feed residents in care", it is alleged that S1 forces food into residents’ mouths, to the point that they will start choking. S6 stated that they had witnessed S1 force-feed residents to the point of choking and leaving bruising on the residents. The administrator and the Current Staff denied the allegation. 5/5 residents also denied the allegations stating they can feed themselves and have not witnessed staff force-feeding other residents. FM1 stated that they have not witnessed a staff force feed a resident, but the food served was “watered-down broth, and there was nothing in the fridge”. FM1 stated that former staff reported the S1 slapped R1 when R1 did not eat. FM2 stated that the facility was not feeding R2 enough and R2 lost weight while in care. LPA observed lunch and did not observe staff force-feeding residents at the time of the visit.

The investigation reveals the following: Regarding "Staff rough handle residents in care", it is alleged that S2 is abusive and aggressive with residents, that she rough handles residents and throw away the resident's food if they take too long to eat it. Interviews with FM1 revealed that they did not witness staff rough-handle residents but heard from a former staff that residents were being rough handled. FM2 stated R2 reported that staff was rough handling, yelling, and mean to residents. S6 stated S2 rough handled residents. During the visit, LPA was informed that S2 is no longer employed at the facility. LPA was unable to contact S2 for an interview. The administrator and Current Staff denied the allegation. 5/5 residents do not remember S2 and denied the allegation.

Based on LPA's interviews, investigation revealed: 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 is UNSUBSTANTIATED.

Exit interview conducted with Laura Hernandez and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

LIC9099 (FAS) - (06/04)

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