198603183-10-28-2025-28-AS-WSHO-DMYSR2-20251031140536

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 10/28/2025
Date Signed: 10/28/2025 02:14:03 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
10/24/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20251024100616

FACILITY NAME:	COUNTRY VIEW ASSISTED LIVING		FACILITY NUMBER:	198603183
ADMINISTRATOR:	SAMUEL DEUTSCH		FACILITY TYPE:	740
ADDRESS:	824 W. CAMERON AVE		TELEPHONE:	(626) 962-3511
CITY:	W. COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	136	CENSUS: 115	DATE:	10/28/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Claudia Cordoba - Wellness Director		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not prevent a visitor from eating a resident's food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Wellness Director. Assistant Administrator Dennise Torres arrived shortly after and assisted with the visit. Purpose of the visit was explained.

During today's visit LPA obtained a copies of Staff and Residents roster, Facility Guest Meal Policy, Notification to Residents & Families about dinning areas and policy. interviewed Assistant Administrator, Staff #1 (S1) and Staff #2 (S2), Resident #1 (R1) through Resident #15 (R15).

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

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 28-AS-20251024100616

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: COUNTRY VIEW ASSISTED LIVING	FACILITY NUMBER: 198603183
	VISIT DATE: 10/28/2025

NARRATIVE

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The investigation revealed the following: Allegation - Staff did not prevent a visitor from eating a resident's food. It was alleged that there is a resident’s family member (visitor) that is constantly eating the resident’s food.

Interviewed Assistant Administrator and staff denied the allegation. Interviewed Assistant Administrator indicated that Family members / visitors often join residents for meals at the facility but never eat residents food/meal. They stated that visitors / guests may bring their own food or purchase a meal from the facility for a small fee. Assistant Administrator stated per Facility Guest Meal Policy visitors they can dine with residents at permitted spaces or in alternative locations. Interviewed S1 stated that facility residents have a right to have a visitor, and visitors are allowed to bring food and share with the residents they are visiting. S1 indicated that facility also provide meals for a low price so residents can enjoy their time with their family members / visitors. Interviewed S2 stated that they often seen family members join their loved ones for meals in the dining room. S2 stated usually visitors bring their own food, but they also have an option to buy food from the facility. Interviewed Assistant Administrator and staff indicated that there is a one resident (R1) who's family member visits him/her almost every day and eats with R1. They stated R1's family member almost always bring their own food and rarely purchase a meal from the facility. Interviewed staff stated they didn't hear complaints that R1's or other residents family members / visitors eat residents food. LPA interviewed 15 residents. They indicated that visitors could bring food, and they can also buy food from the facility. Interviewed residents stated they have not heard anyone complaining about visitors eating residents food. Residents interviewed could not corroborate the allegation.

Based on interviews conducted with facility staff, facility residents and document review there was not enough supportive evidence to concur with the reported allegation. 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 was conducted and the copy of this report was provided to Assistant Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

LIC9099 (FAS) - (06/04)

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