198320460-5-12-2025-11-AS-SCIS-DGR2AT-20250516171357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320460
Report Date: 01/22/2025
Date Signed: 05/12/2025 09:45:08 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2025 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20250115101623

FACILITY NAME:	MOUNTAIN TOP - E. SILVA		FACILITY NUMBER:	198320460
ADMINISTRATOR:	BRADSHAW, AMANDA		FACILITY TYPE:	737
ADDRESS:	1910 E. SILVA STREET		TELEPHONE:	(760) 218-4293
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	4	CENSUS:	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Amanda Bradshaw, Administr		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Allegation: Staff imposed restrictions on resident’s telephone calls

INVESTIGATION FINDINGS:

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On 1/22/25, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by Staff, Patrick Carter and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:

On 1/22/25 LPA Felisa Shirley requested, received and reviewed copies of the following records: Staff Roster and Resident Rosters. LPA Shirley requested the following records for C-1, Physician’s Report, Identification and Emergency information, Personal Inventory List, Admission Agreement, MAR, Conservatorship documents, LIC 613, Harbor Regional Center, Certificate of Consent, 7-Day Individual Behavior Support Plan, Whole Person Assessment, IPP, and copy of gift card from HRC. LPA also interviewed staff 1 thru staff 11(S-1 thru S-11), witness 1 (W-1), and client 1(C-1).

The investigation revealed the following:
Con'd on 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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 11-AS-20250115101623

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MOUNTAIN TOP - E. SILVA	FACILITY NUMBER: 198320460
	VISIT DATE: 01/22/2025

NARRATIVE

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Allegation: Staff imposed restrictions on resident’s telephone calls

It was reported that resident was being restricted to two phone calls per day. LPA Felisa Shirley spoke with S-1 regarding C-1s phone usage. S-1 stated that C-1 received and made a lot of calls, and that resident was on the phone excessively. S-1 was concerned that resident was not accepting incoming calls. S-1 spoke with resident and explained the “Call Waiting” feature on the landline. C-1 was shown what to do if there was a beep to indicate an incoming call. C-1 was told to click the button to accept the incoming call, and how to click back over to resume the call that the resident was on.

LPA Shirley interviewed staff-1 thru staff-11 (S-1 thru S-11). LPA asked, is staff imposing restrictions on resident’s telephone calls. Of those interviewed, 8 out of 11 staff answered no, and 3 answered yes. LPA interviewed Client-1 (C-1). LPA asked resident, is staff restricting your phone calls. The resident answered, No.

Based on information gathered, LPA did not find sufficient evidence to support the allegation listed above therefore the allegation is unsubstantiated.

There were no deficiencies cited during this visit.

LPA Shirley conducted an exit interview and a copy of this report was signed by the Administrator Assistant, Cory Spight.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC9099 (FAS) - (06/04)

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