197801605-3-14-2024-28-AS-RORN-D3XP7W-20240402110438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 03/14/2024
Date Signed: 03/14/2024 01:44:10 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
12/01/2023 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231201131036

FACILITY NAME:	MOUNTAIN VIEW CENTER		FACILITY NUMBER:	197801605
ADMINISTRATOR:	LAURA HERNANDEZ		FACILITY TYPE:	740
ADDRESS:	715 WEST BASELINE ROAD		TELEPHONE:	(909) 626-6633
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	40	CENSUS: 40	DATE:	03/14/2024
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Daisy Fitter- Office Manager		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff neglect led to resident sustaining severe burns while in care which resulted in hospitalization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannounced complaint visit to the facility for the purpose of delivering findings in regard to the above-mentioned allegation. LPA Maldonado met with Office Manager, Daisy Fitter, and explained the purpose for the visit.

On 12/04/23, LPA Maldonado made an initial visit to the facility. During the visit, LPA obtained a copy of resident/staff rosters, water temperature logs for November-December 2023, conducted a tour of physical plant with staff, Daisy Fitter, and obtained the following documents for Residents# 1-3 (R1-R3): Facesheet, Physician's Report, Needs and Services Plan, Incident Reports for November-December 2023, and hospice care plans. LPA observed resident rooms and common areas to be free of hazards. The hot water was tested and measured between 105*F-109.6*F, which is in compliance. LPA also observed the residents to identify any signs of neglect, abuse, or other immediate health and safety threats. No immediate health and/or safety concerns were observed during the visit.
(Report continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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 28-AS-20231201131036

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: MOUNTAIN VIEW CENTER	FACILITY NUMBER: 197801605
	VISIT DATE: 03/14/2024

NARRATIVE

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The investigation was conducted by the licensing agency's Investigation Bureau (IB) and was assigned to Investigator, Laura Garcia. IB's investigation consisted of the following: Interviews were conducted with Staff#1-3 (S1-S3), Witness# 1-2 (W1-W2), and Hospice Staff#1-2 (H1-H2), and hospital records for Resident#1 (R1) were obtained. IB was unable to interview R1 due to R1's cognitive impairment and being non-verbal.
IB's investigation revealed the following:
Regarding allegation: Staff neglect led to resident sustaining severe burns while in care which resulted in hospitalization.
It is alleged that on 11/29/23, R1 was taken to the hospital with severe burns/blisters to R1's face, back, arms and hands, and was reported by facility staff it was possibly due to a chemical reaction. Per IB's interviews conducted, (3) of (3) staff denied neglect/lack of care and supervision to R1, which resulted in R1 sustaining severe burns/blisters. Per staff, on 11/29/23, H2 was providing R1 with a shower. During the shower, H2 noticed R1's skin beginning to redden and immediately notified S3 of it. S3 went to check on R1 and observed the reddening/irritation and notified S1 of the incident. S1 then notified R1's responsible party of the incident and and medical attention was sought for R1 and R1 was taken to the hospital for treatment. IB attempted to interview R1 but was unable to due to R1's cognitive impairment and being non-verbal. Per interviews conducted, (2) of (2) witnesses denied staff being neglectful or unable to provide adequate care and supervision to residents in care W1 denied facility staff being responsible for R1's burns sustained. Per interview with W1, H2 was the only individual responsible for providing showers to R1. W1 stated to have been notified immediately of the incident occurred on 11/29/23, by the facility. Per hospital records obtained, IB discovered that on 11/29/23, R1 was brought to the hospital and presented with blistering wounds on R1's face, back, and hands. The medical decision was stated to be consistent with scalding hot burns. Per IB's interview conducted with H2, H2 stated to be the only individual responsible for providing R1 with showers. H2 admitted that on the noted date, H2 came to the facility at about 8:30AM to give R1 a shower. H2 tested the water prior to showering R1 and felt it was at a comfortable temperature. While showering R1, H2 immediately noticed that R1's skin began to redden/blister and immediately notified S3 of it and left the facility. Facility staff were not responsible for R1's showers. Therefore, this allegation is Unsubstantiated.
LPA Maldonado agrees with IB's investigation and findings.
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.
Per California Code of Regulations, Title 22, and Health & Safety Code, no deficiencies were observed or cited during the visit.
Exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC9099 (FAS) - (06/04)

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