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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 12/04/2025
Date Signed: 12/04/2025 05:47:52 PM

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
11/24/2025 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20251124092808
FACILITY NAME:COUNTRY VIEW ASSISTED LIVINGFACILITY NUMBER:
198603183
ADMINISTRATOR:SAMUEL DEUTSCHFACILITY TYPE:
740
ADDRESS:824 W. CAMERON AVETELEPHONE:
(626) 962-3511
CITY:W. COVINASTATE: CAZIP CODE:
91790
CAPACITY:136CENSUS: 111DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Claudia Gordoba TIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff prevented a resident from attending a medical appointment.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Welness Director. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained.

The investigation consisted of the following: LPA Margaryan toured the facility, conducted interviews with Administrator, Staff 1 to Staff 3 (S1 to S3) and Resident 1 to Resident 11 (R1 to R11). Also staff and residents roster were requested.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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-20251124092808
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: COUNTRY VIEW ASSISTED LIVING
FACILITY NUMBER: 198603183
VISIT DATE: 12/04/2025
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
Allegation - Staff prevented a resident from attending a medical appointment. It was alleged that resident had a medical appointment and the staff cancelled resident’s appointment.

Interviewed Administrator and staff denied the allegation. Interviewed Administrator and staff stated that facility has a designated case manager who assist residents with scheduling medical appointments and arranging transportation. Interviewed staff stated that they support all residents who request assistance. Interviewed Administrator mentioned all appointments are scheduled and attended as planned. Appointments are never cancelled by staff unless the resident requests the cancellation or medical office contacts the facility to reschedule. All cancelled or rescheduled medical appointments are noted in the calendar that is used in Quick Mar Program (copies of the samples were provided). Eight residents (8) out of eleven (11) residents interviewed stated that facility staff assist them with doctor's appointments. Three (3) residents out of eleven (11) residents stated that they make doctors’ appointments by themselves. Ten (10) residents out of eleven (11) residents stated that staff didn't cancel their medical appointments without the reason or without their knowledge. One (1) resident out of eleven (11) residents stated that staff cancelled their medical appointment. Resident was not able to provide medical appointments day and staff's name who cancelled their medical appointment. Based on the information gathered, there is insufficient evidence to support this allegation.

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.

An exit interview was conducted with the Administrator. A copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2