197801605-1-20-2023-28-AS-TVAO-CNNNDJ-20230202092222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 01/20/2023
Date Signed: 01/20/2023 10:19:06 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
11/25/2020 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201125084256

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: 33	DATE:	01/20/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Laura Hernandez		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Resident(s) sustained multiple pressure injuries due to neglect.
Staff did not seek timely medical attention for residents in care.
Resident is not safely transferred by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to further investigate the above allegations. LPA met with Laura Hernandez and discussed the purpose of today's visit.

On 07/12/22, Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Elvira Cortez and discussed the purpose of this visit. Laura Hernandez (Facility Administrator) arrived at approximately 1010AM and assisted with this visit. During this visit , LPA interviewed R-7, R-8 and R-9 and due to insufficient information, LPA Irra to return at a later time.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20201125084256

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MOUNTAIN VIEW CENTER	FACILITY NUMBER: 197801605
	VISIT DATE: 01/20/2023

NARRATIVE

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On 04/14/22, LPA Irra conducted a subsequent visit to investigate the above allegations. LPA met with Laura Hernandez (Assistant Administrator/S-2) and discussed the purpose of the visit. During this visit, LPA Irra conducted a facility tour, reviewed Resident #1 through Resident #6 (R-1 through R-6) files and obtained relevant documentation. LPA Irra also interviewed Staff #2 through Staff #4 (S-2 through S-4) The initial 10 day investigation visit was conducted on 11/30/2020 by LPA Linda Almaraz. The following occurred during this visit: LPA conducted a virtual tour of the living room, dining area, kitchen, outside patio, common areas and resident rooms. Resident rooms and common areas were properly furnished. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats.

Allegation: Resident(s) sustained multiple pressure injuries due to neglect. During this investigation, LPA Irra reviewed resident records, obtained relevant documentation and interviewed staff. LPA was unable to interview residents R-1 through R-6 (R-1 is deceased, R-2 moved out, R-3 moved out, R-4 is deceased, R-5 is non-verbal and R-6 moved out). LPA interviewed R-7 through R-9, however, they did not have any knowledge of residents sustaining multiple pressure injuries due to neglect. Staff interviews revealed R-1 received wound care services for a pressure sore provided by a hospice agency. LPA obtained records for R-1's wound care treatment provided by the hospice agency. Staff interviews revealed that R-5 did not have any pressure injuries. LPA was unable to locate any documentation in R-5's records indicating that R-5 had pressure injuries. Staff interviews and collected documentation do not corroborate this allegation.

Allegation: Staff did not seek timely medical attention for residents in care. During this investigation, LPA Irra reviewed resident records, obtained relevant documentation and interviewed staff. LPA was unable to interview residents R-1 through R-6 (R-1 is deceased, R-2 moved out, R-3 moved out, R-4 is deceased, R-5 is non-verbal and R-6 moved out). LPA interviewed R-7 through R-9, however, they did not have any knowledge of staff not seeking timely medical attention for residents in care. R-7 through R-9 indicated they receive medical attention in a timely manner and do not have any concerns. Staff interviews revealed that they do not recall seeing R-3 having a big bump on R-3's left side of the forehead. LPA was unable to locate any documentation in R-3's records indicating that R-3 had injuries on R-3's left side of the forehead. Staff interviews and collected documentation do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201125084256

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MOUNTAIN VIEW CENTER	FACILITY NUMBER: 197801605
	VISIT DATE: 01/20/2023

NARRATIVE

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Allegation: Resident is not safely transferred by staff. During this investigation, LPA Irra reviewed resident records, obtained relevant documentation and interviewed staff. LPA was unable to interview residents R-1 through R-6 (R-1 is deceased, R-2 moved out, R-3 moved out, R-4 is deceased, R-5 is non-verbal and R-6 moved out). LPA interviewed R-7 through R-9, however, they did not have any knowledge of residents not being safely transferred by staff. R-7 through R-9 indicated they do not have any concerns. Staff interviews revealed R-5 previously had regular hoyer lift which was fully operational. Staff interviews revealed that R-5 hoyer lift was upgraded to an electric hoyer lift. Staff interviews revealed that R-5 has not fallen during the use of the hoyer lift and staff have not had any issues with transferring.

Based on LPA's interviews conducted and records reviewed, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted, appeal rights and a copy of this report was provided to Laura Hernandez

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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