198603183-8-18-2022-28-AS-RORN-CSYMG9-20230620093534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 08/18/2022
Date Signed: 08/18/2022 01:42:39 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
03/11/2022 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220311155840

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: 115	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Dennise Torres; Assistant Administrator		TIME COMPLETED:	01:57 PM

ALLEGATION(S):

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Staff caused injuries to a resident while in care.
Untrained staff.
Staff member mismanages residents' medication.
Staff failed to provide adequate food service.
Staff failed to provide a comfortable environment for residents in care.
Staff threatened resident.
Staff failed to treat residents with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced subsequent complaint visit regarding the above stated allegations. LPA met with Dennise Torres and explained the reason for the visit.

Investigation consisted of the following: during initial visit conducted on 03/14/22, LPA obtained copies from Resident #1 and Resident #2 files such as Identification and Emergency Information Sheets, Physician Reports, Resident Appraisals, eMAR's for February & March, and Incident Reports. During today's visit LPA toured the facility including the common areas and kitchen and interviewed the Assistant Administrator, Staff #1 - Staff #5 and Resident #1 - Resident #10.

The investigation revealed the following: in regards to the allegations "staff caused injuries to a resident while in care" and "untrained staff", it is alleged that on 03/03/22 a facility staff member scratched R1's arms all over while taking her blood pressure. Staff members are allegedly untrained on how to take residents blood pressure. Interviews conducted with staff members denied the allegations. Staff members interviewed indicated some residents are on blood thinners which cause residents to bruise easily. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR 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)

Page: 1 of 3

Control Number 28-AS-20220311155840

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: 08/18/2022

NARRATIVE

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Staff members interviewed indicated they do not purposely injure or harm residents. Staff members interviewed indicated they received on the job training at the facility and continue to receive ongoing training. Staff members interviewed denied scratching R1's arm while taking their blood pressure. 8 out of 10 residents interviewed indicated staff have not hurt or injured them while receiving assistance from staff. LPA reviewed random sample of staff training on file and observed staff training to be up to date. Therefore there was insufficient evidence to corroborate with these allegations.

In regards to the allegation "staff member mismanages residents' medication", it is alleged that staff members make errors while passing out medication. No other details available. Interviews conducted with staff members denied the allegation. Staff members interviewed indicated they ensure they are passing out the correct medication to the residents by double checking the medication and asking the resident for their name before passing out the medication. Staff members interviewed indicated medications are logged in their computer system and are given to residents as prescribed by their physicians. LPA selected a random selection of resident medications for review and observed medications were at facility, logged properly, and given as prescribed. 8 out 10 residents interviewed indicated they have no issues with receiving their medications. Therefore there was insufficient evidence to corroborate with the allegation.

In regards to the allegation "staff failed to provide adequate food service", it is alleged that the quality of food at the facility is not good. Interviews conducted with staff members denied the allegation. Staff members interviewed indicated there is a Dietary Supervisor that comes in and ensure meals provided to residents are well balanced. Staff members interviewed indicated they follow the food menu and will provide alternate meals if residents do not want to eat what is being served. LPA toured the kitchen and observed sufficient 2 day supply of perishables and 7 day supply of non-perishables for the number of residents in care. 8 out 10 residents interviewed indicated they are happy with the food service. Therefore there was insufficient evidence to corroborate with the allegation.

In regards to the allegation "staff failed to provide a comfortable environment for residents in care", it is alleged that facility staff will wake up residents at 5am to take their temperatures. Interviews conducted with staff members denied the allegation. Staff members interviewed indicated temperature checks are usually done when medications are being passed around. Some residents need to take medication a few hours prior to eating breakfast, and facility staff will check those residents temperatures as they pass their meds. If residents don't need to take early morning medications, staff will check their temperatures when they are eating breakfast in the dining room. Staff indicated they do not wake residents up to check their temperatures. Therefore there was insufficient evidence to corroborate with the allegation. (CONTINUED ON 9099C)

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR 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

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220311155840

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: 08/18/2022

NARRATIVE

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In regards to the allegations "staff threatened resident" and "staff failed to treat residents with dignity and respect", it is alleged that staff members are mean and speak inappropriately towards residents. Staff members interviewed denied the allegations. Staff members interviewed indicated they don't threaten the residents or speak to the residents inappropriately. 8 out of 10 residents interviewed indicated they are happy with staff and they don't feel threatened or disrespected by staff. Therefore there was insufficient evidence to corroborate with the allegations.

Based on statements and interviews conducted with staff, residents, review of resident 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 allegation are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR 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

LIC9099 (FAS) - (06/04)

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