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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601496
Report Date: 08/18/2022
Date Signed: 08/18/2022 02:20:40 PM

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
08/11/2022 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220811104711
FACILITY NAME:MONTANA VISTAFACILITY NUMBER:
198601496
ADMINISTRATOR:CAROLYN WESTFACILITY TYPE:
735
ADDRESS:355 WEST MONTANA STREETTELEPHONE:
(626) 398-8519
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:6CENSUS: 4DATE:
08/18/2022
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Jana West (Supervisor)TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yell at residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. LPA met with Jana West (Supervisor) and explained the purpose of the visit.

During today's visit, LPA obtained a copy of the Staff/Client roster. LPA interviewed Staff #1 to #3 in the dining area and interviewed 2 Clients in their bedrooms.

In regards to the allegation: Staff yell at residents in care. Interviews with 3 of 3 Staff indicate they have never yelled at a Client nor have they witnessed other Staff yell at Clients. Interviews with 2 of 2 Clients indicate Staff have never yelled at them nor have they witnessed Staff yell at other Clients.

Based on LPA's interviews, the investigation revealed: 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.

Exit interview conducted with Jana West and a copy of this report provided.

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
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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