198603183-6-17-2020-28-AS-MVAO-BQNSVX-20200617141328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 06/16/2020
Date Signed: 06/17/2020 08:52:17 AM

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
06/04/2020 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200604113938

FACILITY NAME:	COUNTRY VIEW ASSISTED LIVING		FACILITY NUMBER:	198603183
ADMINISTRATOR:	ALBA, HELEN		FACILITY TYPE:	740
ADDRESS:	824 W. CAMERON AVE		TELEPHONE:	(323) 309-2026
CITY:	W. COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	136	CENSUS: 108	DATE:	06/16/2020
		UNANNOUNCED	TIME BEGAN:	12:22 PM
MET WITH:	Samuel Deutsch & Denisse Torres		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handle residents in a rough manner.
Staff speak inappropriately to residents.
Staff mishandling residents' medications.
Facility is infested with roaches.
Facility is in disrepair.
Staff is not meeting residents' medical needs.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) David Sicairos initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Samuel Deutsch.

The investigation consisted of the following: during the initial televisit conducted on 06/09/20, LPA requested copies of resident & staff rosters, recent Pest Control Invoices, and recent washer/dryer repair Invoices. LPA also interviewed the Administrator and Staff #1 - Staff #4 over the phone. On 06/12/20, LPA interviewed Resident #1 - Resident #9 over the phone.

The investigation revealed the following: in regards to the allegations "staff handle residents in a rough manner" and "staff speak inappropriately to residents", it is alleged that facility staff have been physically and verbally abusing the residents by yelling, cursing, and pushing them. The complaint did not provide details regarding which staff member/s were involved. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

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 28-AS-20200604113938

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: 06/16/2020

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

Interviews conducted with staff members all indicated that they do not handle residents in a rough manner nor do they speak inappropriately to the residents. Staff members interviewed also indicated that they have all received training in regards to Personal Rights. Interviews conducted with residents all indicated that they have never been handled in a rough manner nor have staff members spoken to them inappropriately. Therefore there was insufficient evidence to corroborate with these allegations.

In regards to the allegation "staff mishandling residents medications", it is alleged that staff members administer wrong medications. The complaint did not provide details as to which staff member/s are administering wrong medications or which residents are receiving the wrong medications. Interviews conducted with staff members who administer medications indicated that they follow doctor's orders when administering medications. Staff members indicated that everything is logged electronically for each resident. LPA reviewed a random sample of Medication Administration Records (eMAR) for several residents and observed that medications are logged correctly and facility has the correct medications for the residents. Interviews conducted with residents all indicated that they receive their correct medications timely. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "facility is infested with roaches", it is alleged that the facility has an infestation of roaches, however no other details were provided. Administrator provided several Terminix invoices demonstrating that facility is receiving preventative spraying services every other week. 2 out of the 9 residents interviewed indicated that they have seen dead roaches outside of the building, but never in their rooms. All residents interviewed indicated they believe staff is doing a good job cleaning the facility. Staff members interviewed denied that the facility is infested with roaches and indicated deep cleaning is done on a day-to-day basis. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "facility is in disrepair", it is alleged that the facility's microwave and Laundromat have been out of service for a long time, no other details provided. Administrator indicated that the facility does not provide microwaves to its residents, however they are free to purchase their own if they wish to do so. Administrator indicated there are multiple microwaves in the kitchen and they have all been operable. In regards to the Laundromat, Administrator indicated that facility outsources their washing/drying to an outside company however there is a washer and dryer available to residents. Per review of Service Report, on 05/27/20 a technician was out at the facility and replaced a part in the dryer. (CONTINUED ON 9099C)

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20200604113938

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: 06/16/2020

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

Administrator indicated that facility contacts the service repair company as soon as they are made aware of any issues and company usually comes out to repair the issue within 24-48 hrs of submitting the request. Interviews conducted with residents indicated that they have not had any issues with the Laundromat and most of the residents interviewed indicated that staff washes their clothing. Therefore there was insufficient evidence to corroborate with the allegation.

In regards to the allegation "staff is not meeting residents medical needs", it is alleged that facility is not allowing residents to go out for their medical appointments. No other details were provided. Interview conducted with the Administrator indicated that facility is trying to limit how often residents come and go from the facility due to the high risk population they serve. However, Administrator indicated residents are not prohibited from leaving the facility. Administrator indicated some visits with doctors are being done via Zoom, Facetime, Google Duo, etc. There is also an inhouse doctor that comes to the facility once a week. Dermatologists, Podriatists, Optometrists, etc. come in in a "as needed basis". Interviews conducted with residents all indicated that they have either spoken to their doctors over the phone or have had some sort of "tele-health" visit with them recently. Therefore there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Telephonic exit interview held, and a copy of this report was emailed to Administrator for signature.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3