197609594-8-20-2022-31-AS-RRAZ-CKTS6H-20221103133559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 08/20/2022
Date Signed: 08/20/2022 02:55:44 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:	08/20/2022
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Lizette Halili - Staff		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not cleaning resident(s) rooms

Insufficient staffing to meet the needs of the resident(s)

Resident(s) call lights not answered timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with staff Lizette Halili and explained the reason for the visit.

LPA conducted physical plant at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:20 AM and interviewed residents and staff between 10:50 AM to 2:00 PM.

Regarding the allegation that staff are not cleaning resident(s) rooms, it was alleged that no one is cleaning residents' room as they were dirty and unkempt. LPA's interview with nine (9) residents or more than 14% of current census, today between 10:50 AM to 2:00 PM revealed that nine (9) out of nine (9) residents stated that staff clean their room everyday and do general cleaning once a week. LPA's observation on 08/17/22 at 10:35 AM also revealed that twelve (12) out of twelve (12) room visited were clean and in proper order. (continued on LIC 9099-C)

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: 08/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2022

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: 08/20/2022

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that there is insufficient staffing to meet the needs of the resident(s), it was alleged that the facility lacked enough staff that residents' need are not being met. LPA's interview with nine (9) residents or more than 14% of current census, today, between 10:50 AM to 2:00 PM revealed that nine (9) out of nine (9) residents believe that the facility has sufficient staffing and all their needs are being met. LPA's interview with four (4) care staff today between 10:50 AM to 2:00 PM, also revealed that four (4) out of four (4) staff believe that they have sufficient staffing and they provide the care that the residents' deserve and need.

Regarding the allegation that residents' call lights not answered timely, it was alleged that many residents that pulled their cords have to wait a long time to get staff to assist them. LPA's interview with nine (9) residents or more than 14% of current census, today, between 10:50 AM to 2:00 PM revealed that seven (7) out of nine (9) residents believe that the facility staff almost always come within reasonable time whenever they pull their cord and the other two (2) residents had not pulled their cord during their stay at the facility.

Based on the information gathered during this and prior visits, there is insufficient 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: 08/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2022

LIC9099 (FAS) - (06/04)

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