198320460-5-12-2025-11-AS-SCIS-DGR2AS-20250516171357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320460
Report Date: 02/20/2025
Date Signed: 05/12/2025 09:44:18 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: 2	DATE:	02/20/2025
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Shavonne Cole, DSP Lead		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not allow resident to purchase personal items.
Staff threatened resident.
Licensee did not ensure staff are appropriately trained to provide care to residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 5/12/25, Licensing Program Analyst (LPA) Felisa Shirley conducted a subsequent unannounced visit to this facility. LPA was met by DSP Lead, Shavonne Cole 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) and client 1(C-1).

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

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: 02/20/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff did not allow resident to purchase personal items.

The details of the complaint allege that staff did not allow resident to purchase personal items. LPA Felisa Shirley reviewed C-1’s Personal Items Inventory list from move in date of 12/23/24. C-1 brought items with her during the move-in however, the items were unsuitable. Per interview with S-1, C-1 was issued a gift card from Harbor Regional Center pending the transfer of P&I funds. Harbor Regional Provider Relations Specialist specified the gift card would be used to buy clothing and shoes at this time. LPA reviewed receipts from local stores where the staff used the gift card to purchase clothing, and shoes.

LPA Shirley interviewed staff-1 thru staff-11 (S-1 thru S-11). LPA asked, does staff allow residents to purchase personal items. Of those interviewed, 8 out of 11 staff answered yes, 1 answered no and 2 did not know. LPA interviewed Client-1 (C-1). LPA asked the client, are you allowed to purchase personal items. The client answered, no. Based on information gathered, LPA did not find sufficient evidence to support the allegation, staff did not allow resident to purchase personal items, therefore the allegation is unsubstantiated.

Allegation: Staff threatened resident

It was reported that staff threatened to take away the privileges of C-1 to get her hair done if she were to discuss details of conversations between the resident and a member of staff. LPA spoke with C-1 and asked if she was threatened with physical harm, and C-1 stated no. LPA ask C-1 if she was threatened with promises of taking away her privileges, and C-1 stated no. C-1 stated that no members of staff had ever threatened her at all.

LPA Shirley interviewed staff-1 thru staff-11 (S-1 thru S-11). LPA asked, does staff threaten clients. Of those interviewed, 10 out of 11 staff answered no, and 1 answered yes. LPA interviewed Client-1 (C-1). LPA asked the client, have you ever received any threats from the staff. The client answered, No. Based on information gathered, LPA did not find sufficient evidence to support the allegation, staff threatened the client, therefore the allegation is unsubstantiated.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3

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: 02/20/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Licensee did not ensure staff are appropriately trained to provide care to residents

The details of the complaint allege that staff orientations are rushed and that the staff do not receive the required number of hours for training needed before they are assigned to work on the floor. LPA Shirley reviewed training regulations within Title 22 and training records provided and observed that staff are being trained the required number of hours for instruction before they are assigned to work with persons in care. There is a minimum of 32 hours of on-site orientation required and LPA observed that staff received more hours of instruction that is required.

LPA Shirley interviewed staff-1 thru staff-11 (S-1 thru S-11). LPA asked, is management ensuring that all staff are appropriately trained to provide care to residents. Of those interviewed, 10 out of 11 staff answered yes, and 1 answered no. LPA interviewed Client-1 (C-1). LPA asked, do you believe the staff are appropriately trained to provide care to residents. The client answered, yes. Based on information gathered, LPA did not find sufficient evidence to support the allegation, licensee did not ensure staff are appropriately trained to provide care to residents, therefore the allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are 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: 02/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3