198600002-6-13-2023-28-AS-RORN-CTFL6H-20230705082843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600002
Report Date: 06/13/2023
Date Signed: 06/13/2023 11:47:00 AM

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
06/07/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230607083029

FACILITY NAME:	MOUNTAIN VIEW CARE		FACILITY NUMBER:	198600002
ADMINISTRATOR:	CAROLINE TAN		FACILITY TYPE:	735
ADDRESS:	2622 MOUNTAIN VIEW ROAD		TELEPHONE:	(626) 448-1682
CITY:	EL MONTE	STATE: CA	ZIP CODE:	91732
CAPACITY:	83	CENSUS: 81	DATE:	06/13/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Caroline Tan		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Client was hurt by another client in care.
Staff failed to protect a client in care.
Staff are not providing a safe environment for clients.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Caroline Tan and explained the reason for the visit.
The purpose of the visit is to investigate the above allegations.
At today's visit Staff and Client roster were submitted.
Administrator was interviewed at 9:25 AM.
Client's 1-8 were interviewed from 9:45 AM to 10:45 AM.
Special Incident Report dated 06/01/2023 was submitted.
Files for Client's C 2 and C 5 were reviewed and Physician's Report, Needs and Services Plan and ID page were submitted. LPA reviewed facility video of incident.
In regards to Client was hurt by another client in care. based on interviews conducted, video of the incident and information gathered Client C 8 stated that Client C 2 often jokes around and does playful Kung Fu gestures.Stated that Client C 5 told him she was irritated and annoyed, but believes it was a slight playful
gesture and C 5 was not hurt. Interview with Administrator and Special Incident Report stated that C 5

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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-20230607083029

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 CARE	FACILITY NUMBER: 198600002
	VISIT DATE: 06/13/2023

NARRATIVE

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refused medical treatment and there were no bruises.
Review of video showed C 2 walking with C 5 and doing kung fu moves, but no physical contact was observed.
C 8 stated that C 2 always does the kung fu slight gestures and it's always playful and has done it with him directly and has never seen him hurt anyone.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to Staff failed to protect a client in care, based on interviews conducted, video of the incident and information gathered it was revealed that Administrator was notified of the incident by C 5 and acted promptly to offer medical attention and to address the incident with C2 and C5. Administrator had C 2 apologize to C5 who in interview stated she had accepted the apology and feels safe at the facility.
7 of 8 client's interviewed stated that staff protect the client's in care by explaining everything clearly, and if there is an argument they will separate client's and have them apologize and things will then be ok.
Also stated that staff walk around alot and say to keep safe.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the Staff are not providing a safe environment for clients, based on interviews conducted and information gathered 8 of 8 client's interviewed stated that they feel there is a safe environment at the facility.
Client's stated that the staff talk nice and say exactly what they mean.
Said there is enough staff to control them all and if arguing staff jump in right away and that there are no problems here.
Said staff does whatever to protect.
Interview with Administrator who said that she addressed the incident with C 2 and C 5 right away and had them meet with each other and that it was worked out between the 2 and that the facility is safe.
Also submitted Special Incident Report (SIR) right away.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC9099 (FAS) - (06/04)

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