197609594-8-17-2022-31-AS-RRAZ-CKTS6J-20221103133600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 08/17/2022
Date Signed: 08/17/2022 02:58:36 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2020 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20201124081727

FACILITY NAME:	MOUNTVIEW SENIOR LIVING		FACILITY NUMBER:	197609594
ADMINISTRATOR:	CARMY C JEROME		FACILITY TYPE:	740
ADDRESS:	2640 HONOLULU AVE		TELEPHONE:	(818) 248-6737
CITY:	MONTROSE	STATE: CA	ZIP CODE:	91020
CAPACITY:	131	CENSUS: 64	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	09:57 AM
MET WITH:	Ernest Lewis - Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Insufficient clean linens to meet the resident(s) needs

Resident(s) room is malodorous

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Gary Tan and Rosaura Valenzuela conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPAs met with Executive Director Ernest Lewis and explained the reason for the visit.

LPAs conducted physical plant tour at 10:20 AM, requested copies of facility documents relevant to the investigation at 11:00 AM and interviewed Executive Director and staff between 11:15 AM to 1:30 PM.

Regarding the allegation the there is insufficient linens to meet resident(s) needs, it was alleged that residents are sleeping on dirty sheets and there are not enough sheets for residents in care. LPAs observation today at around 10:35 AM revealed that there are sufficient linens in stock at the facility's multiple linen storage. LPAs also visited twelve (12) residents' room during physical plant tour and observed that twelve (12) out of twelve (12) rooms visited, linens were clean and in good condition. LPAs interview with Maintenance director also revealed that linens are regularly changed for each resident once a week and as needed or upon request.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20201124081727

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MOUNTVIEW SENIOR LIVING	FACILITY NUMBER: 197609594
	VISIT DATE: 08/17/2022

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that the resident(s) room is malodorous, it was alleged that multiple rooms in the facility were dirty and had stained on their carpets. LPA observation today during physical plant tour at 10:35 AM revealed that twelve (12) out of twelve (12) rooms visited, there was no foul odor observed in any of the rooms. LPA observed that all the rooms visited were clean and in order. LPA did not see any room with stain on the carpet. LPA interview with Executive Director at around 12:05 PM, also revealed that they are continuously renovating/upgrading the rooms for the incoming and existing residents.

Based on the information gathered during this visit, there is no sufficient information to support the allegations and therefore deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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