198603183-10-20-2022-28-AS-RORN-CKTMGM-20221103093607

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 10/20/2022
Date Signed: 10/20/2022 11:19:43 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
10/13/2022 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221013112249

FACILITY NAME:	COUNTRY VIEW ASSISTED LIVING		FACILITY NUMBER:	198603183
ADMINISTRATOR:	ALBA, HELEN		FACILITY TYPE:	740
ADDRESS:	824 W. CAMERON AVE		TELEPHONE:	(626) 962-3511
CITY:	W. COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	136	CENSUS: 123	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Claudia Cordoba/S-1 and Dennise Torres/S-2		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff do not open door for residents to enter facility.
Staff do not give resident hot water for coffee.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial investigation for the above allegations. LPA met with Claudia Cordoba/S-1 and discussed the purpose of today's visit. Dennise Torres/S-3 (Assistant Administrator) arrived at approximately 9:50 A.M..

During this visit, LPA obtained a copy of the staff roster, resident roster, interviewed Staff #1 through Staff #4 (S-1 through S-4) and interviewed Resident #1 through Resident #7 (R-1 through R-7). LPA also conducted a facility tour. LPA collected documents relevant to this investigation.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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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Control Number 28-AS-20221013112249

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COUNTRY VIEW ASSISTED LIVING	FACILITY NUMBER: 198603183
	VISIT DATE: 10/20/2022

NARRATIVE

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Allegation: Staff do not open door for residents to enter facility. During this investigation , LPA interviewed Staff #1 through Staff #4 (S-1 through S-4) and interviewed Resident #1 through Resident #7 (R-1 through R-7). Staff interviews revealed that staff open the front door for residents and visitors. Staff interviews revealed that the front door is equipped with a camera/doorbell which is connected to the staff tablet. Per staff interviews, the tablet receives alerts when there is someone at the front door and it is also connected to the doorbell. Staff interviews revealed that at times there are some residents around the entrance "beat" the staff in opening the door. Staff indicated they have not received any complaints/concerns in regards to the staff not opening doors for residents. Resident interviews revealed that staff open the door promptly. Resident interviews revealed that they have not heard anyone complain about the staff not opening the door. During this visit, LPA observed staff opening the front door promptly, observed a sign on the door stating "NOTICE PLEASE RING BELL FOR SERVICE" and LPA reviewed the live feed of the front door and tested the doorbell and the notification to the staff tablet. Staff and resident interviews also revealed that the Assistant Manager is present at this facility and has "banking hours" posted to receive payments and provide money to residents that have this facility handle their monies. Per Assistant Administrator, there has not been any eviction notices given to any resident. Staff, resident and observation does not corroborate this allegation.

Allegation: Staff do not give resident hot water for coffee. During this investigation , LPA interviewed Staff #1 through Staff #4 (S-1 through S-4) and interviewed Resident #1 through Resident #7 (R-1 through R-7). Staff interviews revealed that staff provide residents with hot water. Per Staff interviews, the coffee machine dispenses coffee, hot water and luke temperature water. Resident interviews revealed that staff provide hot water for tea or coffee. Staff nor residents have heard anyone complaining about staff not providing hot water for coffee. Staff and resident interviews do not corroborate this allegation.

Although the allegations 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 allegations are unsubstantiated

Exit interview was conducted and a copy of this report and appeal rights were provided to Dennise Torres.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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