198603183-10-14-2023-28-AS-TVAO-CWPL9A-20231017083310

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 10/14/2023
Date Signed: 10/14/2023 11:02:36 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
09/27/2022 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20220927150112

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: 136	DATE:	10/14/2023
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Fatima Hernandez - Med-Tech		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff are not transporting resident to appointments
Staff are not providing residents with mail in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint vist to provide additional information for report dated 6/13/23. investigation visit regarding the above allegations. LPA met with Fatima Hernandez and explained the reason for the visit.

The investigation consisted of the following: On 10/6/22 LPA Katrdzhyan conducted an initial investigation visit and requested pertaining documents. On 6/13/23 LPA Katrdzhyan conducted a subsequent complaint investigation visit and delivered findings for the above allegations. On 6/14/23 LPA Katrdzhyan delivered findings for additional allegations regarding this complaint. On 10/9/23 LPA Flores conducted interviews over the phone with 8 residents and 5 staff to obtain additional information regarding the above allegations. On 10/14/23 LPA Flores delivered and obtained signatures for this report.

(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2023

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-20220927150112

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: 10/14/2023

NARRATIVE

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The investigation revealed the following: Regarding allegation: Staff are not transporting resident to appointments. It is alleged facility staff keep canceling resident’s rides to appointments. Interviews conducted with residents revealed 8 out of 8 residents stated to received assistance with transportation to appointments. Residents stated appointments to medical or dental services are only cancel when the residents are not feeling well. When their transportation is late, facility staff either reschedule their appointment or if possible, they provide an Uber for them to make it to their original appointment. Interviews with staff revealed 5 out of 5 staff stated residents transportation depends on their medical insurance. Transportation is provided for their medical appointments and if their transportation is late, facility schedules an Uber ride to their appointments. The only time residents miss an appointment is if the residents stated they don’t feel well to go to their appointment or when their scheduled transportation is late, and the medical offices is not able to take them because they are late. Facility then reschedules the appointment for the residents. Per interviews conducted when a resident misses an appointment it is rescheduled to ensure the resident goes to their medical or dental appointments.

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.

Regarding allegation: Staff are not providing residents with mail in a timely manner. It is alleged that residents don’t get their mail timely. Interviews conducted with residents revealed 8 out of 8 residents stated that they received their mail in a timely manner, delivered by facility staff. Interviews conducted with 5 out of 5 staff revealed that the activity director delivers residents mail during mealtimes or take it to their rooms Monday through Friday and a Med-Tech provides their mail on the weekends. Administrator stated the mail comes to the facility and they pull out mail for the facility, it is then given to the activity director or Med-Tech who provides it to the residents on the same day. The activity director stated that the only time mail is not delivered to the residents is when the residents are out in the hospital. Per interviews conducted there are no concerns about mail being provided late to the residents.

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.

*All findings concerning this complaint were addressed on 6/14/23 and remained the same. *

Exit interview was conducted with Fatima Hernandez and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2023

LIC9099 (FAS) - (06/04)

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