198603183-2-27-2024-28-AS-RORN-D5PTNX-20240528145324

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:51:21 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
02/20/2024 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20240220153225

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: 133	DATE:	02/27/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Fatima Hernandez		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not prevent the roof from leaking
Staff are not providing adequate food service to resident
Staff are unprofessional towards resident
Staff did not prevent a resiednt from stalking resident
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Nune Margaryan conducted a visit in response to the above allegations. On today's visit, LPA met with staff Fatima Hernandez. Assistant Administrator Dennise Torres arrived shortly after, who assisted with the visit. Purpose of the visit was explained.

The investigation consisted of the following: Interview(s) with Assistant Administrator, and staff #1 -staff #4, interviews with resident #1- resident #7, tour the facility, kitchen, review of facility food supply, and facility menu. Facility Staff and Residents roster were obtained.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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-20240220153225

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: 02/27/2024

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

The investigation revealed the following: Regarding the allegation that Staff did not prevent the roof from leaking, it was alleged: the roof is leaking in room #57, by the Coke machine, and the front office.

At the time of visit LPA tour the facility and observed that Maintenance staff working at the front area. Area was closed off with the yellow caution tapes and was inaccessible to residents and visitors. Interviewed Assistant Administrator stated that roof was leaking because of heavy rains. Facility contacted with 2 construction companies and roof was fixed 2 times. On 12/23/24 Sky Tech Roofer Inc. fixed the roof, but in January roof started leaking again and on 01/18/24 facility hired YAY Construction INC. to fix the roof again. Per Assistant Administrator, there are currently no roof leaks reported. Stated that maintenance staff is patching the ceiling now and it will be painted after. Invoices were provided to LPA. Interviewed staff denied that staff does not prevent the roof from leaking. They stated that Facility administration is working on this issue since heavy rains started. Interviewed residents stated that roof is leaking in the front area but not in their rooms. LPA inspected 6 rooms (#54, #56, #57, #61, #62, #64) and did not observe any water damage or leak in the residents’ rooms. At the time of visit LPA did not observe any health and safety issues for the residents.

Regarding the allegation that Staff are not providing adequate food service to resident, it was alleged that the food is not good, specifically the coffee.

Staff interviewed denied the allegation. There is adequate food service to resident. Staff stated that the food served is sufficient and of good quality. No one complaints about the food or coffee. Residents interviewed were unable to corroborate the allegation. 7 out of 7 residents interviewed stated that staff providing adequate food service. They stated that food served is of sufficient quantity and quality and coffee is good. LPA observed that the facility had a sufficient amount of food during today's visit, and it was of good quality.

Regarding the allegation that Staff are unprofessional towards resident, it was alleged that the staff are unprofessional and don’t say, “Hi.”

Staff interviewed denied the allegation. Staff stated that staff communicate with residents, and they speak to them in a respectful, polite manner. They always say "Hi", "Hello" to residents. Residents interviewed were unable to corroborate the allegation. 7 out of 7 residents stated that staff communicate with them in a polite manner.

Continue 9099C

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20240220153225

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: 02/27/2024

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

Regarding the allegation that Staff did not prevent a resident from stalking resident, it was alleged that a resident (no name) is stalking another resident.

Staff interviewed denied the allegation. Interviewed Assistant Administrator stated that staff are doing everything to prevent residents from engaging in inappropriate behaviors / stalking and staff always ensure to provide a safe environment for all residents in care. Assistant Administrator stated that the facility ensures that the facility environment is safe at all times. Stated no one reported that resident stalking to another resident. Interviewed staff stated that staff do prevent residents from engaging in inappropriate behaviors / stalking and the facility does provide a safe environment for residents in care. 7 out of 7 residents stated that they didn't witness or heard that residents stalking another resident.

Regarding the allegation that Staff did not safeguard resident's personal belongings, it was alleged that resident glasses and watch were stolen.

Interviewed Assistant Administrator stated that residents have their own keys, and they recommend residents to lock their rooms whenever they leave and do not leave things unattended. Interviewed staff stated that they didn't hear complaints from any residents that their glasses or watch were stolen. They stated residents usually misplaced items and staff looks and will find items in residents' rooms. Staff stated that they respect the residents, they do not go inside the resident's room without permission and do not touch their items. 7 out of 7 residents stated to not have lost or missing items from their rooms. They stated sometimes they misplaced items and staff help to look and find them. They did not hear that someone complains about missing, stolen items.

Based on the observation, documents review, and interviews conducted with residents and staff, there was not enough supportive evidence to corroborate the 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.

Exit interview conducted, and a copy of report was provided to Assistant Administrator Dennise Torres.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3