198602384-7-9-2020-11-AS-MVAO-BSENYT-20200812105315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602384
Report Date: 07/09/2020
Date Signed: 07/09/2020 04:23:01 PM

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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2020 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20200630110406

FACILITY NAME:	FOUNTAINVIEW AT GONDA WESTSIDE		FACILITY NUMBER:	198602384
ADMINISTRATOR:	STEWART, BRADLEY THOMAS		FACILITY TYPE:	741
ADDRESS:	12490 WEST FIELDING CIRCLE		TELEPHONE:	(424) 216-7788
CITY:	PLAYA VISTA	STATE: CA	ZIP CODE:	90094
CAPACITY:	286	CENSUS: 240	DATE:	07/09/2020
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Charlette Ofrecio-Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff engaging inappropriately with resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a complaint investigation for the allegations listed above. Due to the situation surrounding Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Charlette Ofrecio, facility administrator.

The investigation consisted of the following:
On 7/1/2020 LPA Cifuentes conducted a telephone video call with the administrator. During the call, LPA Cifuentes spoke with administrator and conducted a tour of facility grounds. LPA was shown lounges, dining room, kitchen, meeting room and resident apartments both in assisted living and in memory care. LPA requested and received the following documents: physician’s report, needs and services plan, case notes, ID and emergency identification for Resident 1 and Resident 2 as well as staff and client roster, and staff schedules for the April, May and June

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2020

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-20200630110406

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: FOUNTAINVIEW AT GONDA WESTSIDE	FACILITY NUMBER: 198602384
	VISIT DATE: 07/09/2020

NARRATIVE

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Regarding the allegation: Facility staff engaging inappropriately with resident

The investigation revealed the following:

On 7/1/2020 LPA toured facility grounds with facility administrator and was shown lounges, dining room, kitchen, meeting room and resident apartments both in assisted living and in memory care

On 7/7/2020 LPA reviewed facility files and on 7/8/2020 LPA interviewed residents 1 through 10. Of the residents interviewed 10 out of 10 stated staff had not engaged inappropriately with them in the past three years. Upon further questioning 9 out of 10 clients stated they had not heard or seen any staff engaging in inappropriate behavior with clients.

On 7/8/2020 LPA Cifuentes interviewed staff 1-6. Of those interviewed 6 out of 6 staff stated they had not witnessed any staff engaging in inappropriate behavior with residents. LPA also asked if any residents acted inappropriately with staff. 6 out of 6 of those staff interviewed stated that residents had not acted inappropriately towards them.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of the report was emailed to Charlette Ofrecio, executive director.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2020

LIC9099 (FAS) - (06/04)

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