<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 01/25/2024
Date Signed: 01/25/2024 11:58:00 PM

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
11/09/2023 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231109122637
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: 37DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator HernandezTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff pushed a resident in care.
Staff pinched a resident in care.
Staff stomped on a resident in care.
Staff used foul language towards residents.
Staff left resident in the same clothing for a long period of time.
Staff discouraged a resident from reporting an incident to Law Enforcement.
Staff did not serve a meal to a resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint investigation visit on 01/25/2024 to deliver findings regarding the above allegation(s). LPA Ramirez was met by Administrator Hernandez and explained the purpose of the visit.

The investigation consisted of the following: Initial complaint investigation was conducted on 11/13/2023LPA Ramirez requested and obtained copies of Staff Roster (LIC 500), Resident Roster (LIC 9020), Staff #1 - 6 interviews (S1 – S6), Personnel Records for Staff # 1-6 (S1-S6), Resident#1-3 interviews (R1- R3), attempted interview of resident#4 (R4) copies of resident #1, 2, 3 (R1- R3) physician report, face sheet, and other pertinent documents related to this investigation and physical plant tour.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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-20231109122637
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: 01/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following: Regarding Allegation(s): Staff pushed a resident in care- It is alleged staff pushed R1 against wall. Four (4) out of six (6) staff interviewed deny this allegation. Three (3) out of three (3) residents interviewed deny this allegation. LPA Ramirez reviewed R1’s facility records and did not observe any documentation of injury from suspected fall or from being pushed. During interview of R1, LPA did not observe any visible injuries. 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 allegations are UNSUBSTANTIATED.

Staff pinched a resident in care- It is alleged facility staff pinches R4. Four (4) out of six (6) staff interviewed deny this allegation. Three (3) out of three (3) residents interviewed deny this allegation. LPA Ramirez reviewed R4’s resident record and did not observe any documentation of injury sustained from a pinch or suspected pinch. LPA Ramirez attempted to interview R4 but was unable to due to R4 refusing to answer questions. 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 allegations are UNSUBSTANTIATED.

Staff stomped on a resident in care- It is alleged facility staff stomp on R4. Four (4) out of six (6) staff interviewed deny this allegation. Three (3) out of three (3) residents interviewed deny this allegation. LPA Ramirez reviewed R4’s resident record and did not observe any documentation of injury sustained from a stomp or suspected stomp. LPA Ramirez attempted to interview R4 but was unable to due to R4 refusing to answer questions. 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 allegations are UNSUBSTANTIATED.

Staff used foul language towards residents- It is alleged facility staff use foul language against residents in care. Four (4) out of six (6) staff interviewed deny this allegation. Three (3) out of three (3) residents interviewed deny this allegation. During tour of facility on 11/13/2023, LPA Ramirez observed staff providing care and supervision to residents. LPA Ramirez did not observe any staff using foul language towards residents. LPA Ramirez reviewed six (6) personnel records and did not observe documentation that staff was reprimanded for use of foul language towards residents. 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 allegations are UNSUBSTANTIATED.

SEE 9099-C for continuation.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20231109122637
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: 01/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff did not serve a meal to a resident in care- It is alleged staff did not serve R3 a meal due to R3 refusing to change clothing. Four (4) out of six (6) staff interviewed deny this allegation. Three (3) out of three (3) residents interviewed deny this allegation. LPA Ramirez toured kitchen on 11/13/2023 and observed sufficient supply of perishables and non-perishables. LPA Ramirez reviewed R3 resident record and did not observe documentation that suggest staff withheld meals to R3. LPA Ramires did not observe documentation that suggest R3 became ill or malnourished due to being denied meals. 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 allegations are UNSUBSTANTIATED.

Staff left resident in the same clothing for a long period of time- It is alleged staff leave R1 in the same clothing for weeks at a time. Four (4) out of six (6) staff interviewed deny this allegation. Three (3) out of three (3) residents interviewed deny this allegation. During tour of R1’s room, LPA Ramirez observed multiple sets of clothing in R1 closet and dresser. LPA Ramiez observed R1 to be clean clothing during interview. 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 allegations are UNSUBSTANTIATED.

Staff discouraged a resident from reporting an incident to Law Enforcement- It is alleged staff discouraged a resident from reporting an incident to Law Enforcement. Four (4) out of six (6) staff interviewed deny this allegation. Three (3) out of three (3) residents interviewed deny this allegation. Review of six (6) staff records revealed staff signed Statement of Acknowledgement Requirement to Report Suspected Abuse of Dependent Adults and Elders. 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 allegations are UNSUBSTANTIATED.

Exit interview conducted with Administrator Hernandez and a copy of this report and appeals rights was provided

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3