198204377-4-6-2021-28-AS-MVAO-BZZUMM-20210412154234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204377
Report Date: 04/05/2021
Date Signed: 04/06/2021 10:34:41 AM

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
08/24/2020 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200824151739

FACILITY NAME:	MOUNTAIN VIEW COTTAGES - I		FACILITY NUMBER:	198204377
ADMINISTRATOR:	PRISCO CASTILLO		FACILITY TYPE:	740
ADDRESS:	1147 CLEGHORN DR.		TELEPHONE:	(909) 861-8508
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	6	CENSUS: 6	DATE:	04/05/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Jasbindar Singh		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff yell at residents
Staff did not follow Dr. orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicole Spencer initiated a subsequent visit to deliver the findings for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Jasbindar Singh, the house manager.

During the course of the investigation, LPA Spencer conducted telephone interviews with the back-up administrator Trupti Mody, staff #1-4, residents #1-6 and conducted a video call to tour the physical plant. R2, R3, and R5 could not complete interviews so a total of 3 residents were interviewed. The LPA received copies of the staff roster, resident roster and for resident # 1 (R1): physician orders for medication "Northea," MAR chart, Needs and services plan, discharge papers from hospital regarding fall on 7/19/20, and unusual incident report. See LIC9099-C for continuation of this narrative.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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-20200824151739

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 COTTAGES - I	FACILITY NUMBER: 198204377
	VISIT DATE: 04/05/2021

NARRATIVE

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The investigation revealed the following:

Staff yell at residents
R1 stated that S1 and S2 yell at residents. During observations, LPA observed staff speaking calmly to residents. During interviews, S1 and S2 stated that they may have to yell with residents who are hard of hearing but never yell out of anger. S3 stated that she has heard of a resident complaining that staff yells but has not witnessed it. S4 stated that S2 has a strong voice but has not personally heard her yell at residents. 2 out of 3 residents (R1 & R6) stated that staff yell at them loudly on a consistent basis and stated that they are not hard of hearing. A review of the Needs and Services plan for R1 confirms that R1 is not hard of hearing.
Staff did not follow Dr. orders
A review of R1's prescription shows that the medication Northea and Midodrine is to be taken 3 times daily at 2 a.m., 5:30 a.m., and 2 p.m. Interview with R1's nurse practitioner (NP) confirmed that the prescription times listed is correct. The NP said that on 8/17/20 he adjusted the prescription to list the times to take the medication. NP stated that he adjusted it because the patient wanted specific times written on the prescription so that the caregivers would give him the medications at the same time each day to avoid dizzy spells. A review of the MAR logs showed that the medications Northea and Midodrine was provided three times daily but not at a specified time as listed on the prescription. Staff stated that they gave R1 the medications as prescribed 3 times daily but R1 stated that the caregivers did not want to give him the medication at 2 a.m. S1 and S2 stated that they did not give R1 the medication at 2 a.m. because the resident was independent and could take the medication on his own. S3 stated the staff gave him all of his medications except for insulin which was self administered. S4 stated that there was a dispute about the medications because S2 said that the prescription times were wrong and she needed to call the doctor to verify. She stated R1 got mad because they would not follow the prescription orders.

Based on interviews, observation, and record reviews, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. CCR Title 22, Division 6, Chapter 8 is being cited on attached LIC9099D. An exit interview was conducted and copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200824151739

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 COTTAGES - I	FACILITY NUMBER: 198204377
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/05/2021 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 (a)(1) Personal Rights of Residents in all Facilities: Residents in all residential care facilities for the elderly shall... be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by...	1 2 3 4 5 6 7	The house manager stated that she will conduct an in-service training on personal rights, specifically in regards to how to speak to residents. Will send a copy of the training logs to CCL by 4/9/21.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not ensure that staff members spoke to all residents respectfully without yelling. This poses a potential personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 04/05/2021 Section Cited CCR 87465(a)(5)	1 2 3 4 5 6 7	87465(a)(5) Incidental Medical and Dental Care: The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by...	1 2 3 4 5 6 7	The house manager stated that she will conduct an in-service training on administering medications and documentating them on the MAR logs. Will send a copy of the training logs to CCL by 4/9/21.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not ensure that staff followed Dr. orders in ensuring R1 was given prescribed medications at the times listed on the prescription. This poses a potential health risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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