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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 10/29/2024
Date Signed: 10/29/2024 05:02:26 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
10/23/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20241023105126
FACILITY NAME:COUNTRY VIEW ASSISTED LIVINGFACILITY NUMBER:
198603183
ADMINISTRATOR:SAMUEL DEUTSCHFACILITY TYPE:
740
ADDRESS:824 W. CAMERON AVETELEPHONE:
(626) 962-3511
CITY:W. COVINASTATE: CAZIP CODE:
91790
CAPACITY:136CENSUS: 112DATE:
10/29/2024
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Dennise TorresTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff do not ensure resident utilizes restroom.
Staff do not ensure resident is provided a healthy environment.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Assistant Administrator Dennise Torres. Purpose of the visit was explained.

During today's visit LPA obtained a copy of the Staff and Residents roster, interviewed Assistant Administrator, Wellness Director, Staff #1 (S1) and Staff #2 (S2), Resident #1 (R1) through Resident #8 (R8) and toured the facility with Assistant Administrator.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
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-20241023105126
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: 10/29/2024
NARRATIVE
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Staff do not ensure resident utilizes restroom. It was alleged that R1 pees from the porch and staff not done anything about it.
LPA interviewed Assistant Administrator, Wellness Director, staff, residents and toured the facility inside and out including a sample of rooms / porches. Interviews with Assistant Administrator, Wellness Director revealed that in the past R2 brought on Administrator's attention that R1 is urinating from the porch. Assistant Administrator and Wellness Director stated R1 was spoken to immediately and advised that this behavior is not allowed at the facility and R1's actions made other residents uncomfortable. They stated that Administration ensure that R1 was assisted throughout the day and checked that R1's behavior no longer continued. A urinal was also provided and R1 has been moved closer to the bathroom so that R1 has more accessible access to it. R1 was redirected to use restroom located in R1's room and the general resident's restroom that is located a few steps from R1's room. Interviewed S1 stated that they heard that R1 was urinating from the porch, but it was long time ago and Assistant Administrator spoke with the resident. Lately S1 didn't hear any complaints about this matter. Interviewed S2 stated that they didn't hear about resident urinating from the porch. Interviewed R1 stated that it happened once long time ago that they pees from the porch because staff was cleaning bathroom in R1's room. R3 (R1's roommate) stated that in the past R1 was peeing from the porch and lately R3 didn't noticed that R1 doing that. Interviewed R2 stated that lately it's not smell outside and thinks that R1 is not urinating any more from the porch. (1) out of the (8) resident stated didn't hear about resident is urinating outside. (4) out of (8) residents stated that they heard that one resident was urinating outside of porch, but they believe that issue already under the control. Already mouths they didn't hear anything about it.

Continue 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241023105126
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: 10/29/2024
NARRATIVE
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Staff do not ensure resident is provided a healthy environment. It was alleged that R1 pees from his porch and because of strong smell R2 cannot be in the porch.

LPA interviewed staff, residents and conducted a tour of all facility common areas including residents’ rooms and porch areas. LPA observed that they were clean, did not smell any strong odors that would indicate that clients urinate in the common / porch areas. Intervened Assistant administrator, Wellness Director and staff stated that residents at the facility were provided a healthy environment. They stated that facility conducts daily cleaning inside and outside at night and periodic cleaning during the day and cleaning staff aware and they are reporting any urine smell or any incidents that might occur going forward. Assistant administrator and Wellness Director stated that in the past R2 brought on their attention that R1 is urinating from the porch and R2 cannot go to his/her porch because of strong smell of urine. They stated that they spoke with R1 about this immediately and advised that this behavior is not allowed at the facility and R1's actions made other residents uncomfortable. Interviewed residents stated that staff is cleaning the facility every day. Interviewed residents stated that staff providing a healthy environment to residents. They stated that the common areas, rooms, porches are cleaned every day and staff also check common areas, porches throughout the day. Interviewed R2 stated that lately it's not smell outside and thinks that R1 is not urinating any more from the porch.

Based on interviews conducted with facility staff, facility residents, and LPA observations 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 allegations are Unsubstantiated.

Exit interview was conduced and the copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC9099 (FAS) - (06/04)
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