198603183-7-18-2023-28-AS-TVAO-CUXUEC-20230822153056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 07/18/2023
Date Signed: 07/18/2023 11:53:36 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
07/10/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230710102613

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: 117	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Eliana Lopez, Staff		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are stealing resident's personal possessions.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Staff, Eliana Lopez. The purpose of the visit was explained. The assistant administrator, Dennise Torres, arrived at 9:20 a.m. to assist with the visit.

The investigation consisted of the following:
LPA obtained copies of the staff and resident rosters and the Thief and Loss Policy. Interviews were held with the Assistant Administrator, 4 Staff, and 12 Residents.

The investigation revealed the following:
Allegation - Staff are stealing resident's personal possessions. LPA interviewed Staff and Residents regarding this allegation. Per Assistant Administrator, there has not been any recent reports from residents about missing items in their rooms. The items that were reported missing in the past were mainly articles of clothing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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-20230710102613

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: 07/18/2023

NARRATIVE

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If a resident's clothing goes missing during laundry, the facility will replace the item with a new one. She stated that residents fill out the personal property and valuable form when they move in and will update if needed. Staff interviewed stated they have not taken any of the residents' possessions nor heard any residents mentioning items missing to them. When they clean, some of the items are moved but staff will put them back afterwards.
LPA interviewed 12 residents today. One of the residents felt that staff have taken some of the trinkets from the room. 11 out of the 12 stated they have not had any of their belongings taken from them. They lock their rooms to prevent anything from being stolen.

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.

An exit interview was conducted with the Assistant Administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

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