197801605-9-21-2023-28-AS-TVAO-CZ7R56-20240105114233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801605
Report Date: 09/21/2023
Date Signed: 09/21/2023 04:03:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/12/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230512120959

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: 37	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Laura Hernandez, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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1. Staff did not distribute resident's medication as prescribed.
2. Staff did not meet resident's incontinence needs.
3. Staff did not assist resident with showering.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation regarding the allegations listed above. LPA met with Administrator, Laura Hernandez, and explained the reason for the visit.

The investigation consisted of the following:
On 5/16/23, LPA Chan toured the facility and inspected six rooms. LPA also obtained copies of documents pertaining to Resident #1 (R1) and interviewed 2 Staff. Sufficient food supplies of 2-day perishable and a week of non-perishable were observed. There were no immediate health and safety concerns observed during that visit. On 9/21/23, LPA Chan conducted interviews with the Administrator, 3 Staff, and 4 Residents.

(Continue on next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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-20230512120959

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MOUNTAIN VIEW CENTER	FACILITY NUMBER: 197801605
	VISIT DATE: 09/21/2023

NARRATIVE

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Allegation - Staff did not distribute resident's medication as prescribed. It was alleged that the facility was administering medications that were discontinued to Resident #1 (R-1). LPA reviewed the physician’s order form provided to the facility by the hospice agency upon admission on 12/1/22. The medications listed on the facility's medication administration record (MAR) was also reviewed and it did not appear to have any discrepancies. The facility also had physician orders for any new medications that were prescribed after admission. Per interviews with staff, R-1 was overall compliant with the medications. Staff had initialed the MAR logs when resident took the medication and/or indicated the reason for not. R-1 had moved out of the facility on 12/28/22.

Allegation - Staff did not meet resident's incontinence needs. LPA interviewed Staff and Residents. The administrator stated that staff check the resident’s diaper every 2 to 3 hours and change as needed. The caregiver will log down if there is a bowel movement. Staff indicated they would check the resident’s diaper a few times during their shifts and change when needed. They do not keep residents in soiled diapers. 3 out of the 4 residents interviewed stated that staff check their diapers and change them if needed. One is able to change it himself/herself but staff would also check on them.

Allegation - Staff did not assist resident with showering. It was alleged that staff did not shower or wash R-1’s hair regularly which caused R-1 to smell bad. The administrator and staff interviewed stated the residents are showered daily. Those on hospice care receive showers through outside personnel, however, facility staff would also provide showers on the other days. Staff stated that R-1 was showered often when allowed, either by the hospice personnel or facility staff. LPA interviewed 4 residents who all stated they get showers frequently.

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.

An exit interview was conducted with the administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

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