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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412145
Report Date: 07/31/2025
Date Signed: 07/31/2025 10:01:36 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2022 and conducted by Evaluator Venus Mixson
COMPLAINT CONTROL NUMBER: 18-AS-20221114171517
FACILITY NAME:MOUNTAIN VIEW RESIDENTIAL CARE FOR THE ELDERLYFACILITY NUMBER:
336412145
ADMINISTRATOR:MARIA ELIZABETH PELAYOFACILITY TYPE:
740
ADDRESS:78805 NOLAN CIRCLETELEPHONE:
(760) 200-5366
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:6CENSUS: 6DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:ADMINISTRATOR, ELIZABETH PELAYOTIME COMPLETED:
10:08 AM
ALLEGATION(S):
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Facility is not meeting resident's medical needs.
INVESTIGATION FINDINGS:
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On July 31, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced and met with Licensee. LPA explained the reason for the visit was to provide findings for the complaint investigation.

On November 14, 2022, Community Care Licensing received a complaint alleging Facility is not meeting resident's medical needs. During the investigation, LPA conducted interviews, record reviews, and made observations. LPA was not able to locate and interview R1 due to R1 passing away. Regarding the allegation facility is not meeting resident's medical needs, it was reported the facility prevented Resident #1 (R1) from obtaining an assessment to determine if a higher level of care was needed. Information obtained from an interview with Administrator denied the allegation. It was stated that R1 requested to be transported to the hospital and was done so immediately. The administrator indicated there was not a request for a need of higher level of care, and there was no information obtained requesting an assessment. Information obtained from interviews with additional staff indicated facility is meeting R1’s medical needs by following the doctors’ orders and making sure R1 attends all medical and dental appointments as required.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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 18-AS-20221114171517
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MOUNTAIN VIEW RESIDENTIAL CARE FOR THE ELDERLY
FACILITY NUMBER: 336412145
VISIT DATE: 07/31/2025
NARRATIVE
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 LPA’s observations of record reviews revealed there was a hospital visit on November 11, 2022. No concerns or advisements were notated. LPA also reviewed weekly notes from the home health nurses attending to R1’s medical needs. A review of the records confirmed there was no documentation requesting assessment for a higher level of care, and R1 was not receiving Hospice Services while residing at the listed facility. Information obtained from interview with additional Witness advised there were no concerns with R1’s medical needs being met. It was stated R1 was receiving the care and services agreed to at the time of admissions.

Based on interviews, record review, observations, and the inability to interview relevant Parties, the allegation Facility is not meeting resident's medical needs has been determined as Unsubstantiated. Although the allegation may have occurred there is not enough evidence to support the listed allegation.

An exit interview was conducted, and a copy of this report was explained and given to Licensee, Elizabeth Pelayo.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2