198603183-7-21-2025-28-AS-WSHO-DKBPEZ-20250807111554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 07/21/2025
Date Signed: 07/21/2025 03:37:06 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
07/16/2025 and conducted by Evaluator Nune Margaryan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250716095553

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:	07/21/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Cordoba Claudia, Welness Director		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff pushed resident.
Staff does not treat residents with dignity or respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegations listed above. LPA met with Welness Director. Assistant Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained.

The investigation consisted of the following: LPA Margaryan conducted interviews with Assistant Administrator, Staff 1 to Staff 3 (S1 to S3) and Resident 1 to Resident 12 (R1 to R12). Also staff and residents roster were requested. At the time of visit R1 was at the Day Program and was interviewed over the phone.

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: 07/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

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-20250716095553

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: 07/21/2025

NARRATIVE

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Investigation revealed the following: Regarding allegation: Staff pushed resident. It was alleged that S1 pushed R1 and walked away.

Interviewed Administrator and staff denied the allegation. They stated that staff never pushed the residents. The interviewed Assistant Administrator stated that on 07/07/25 R1 reported to them that R1 was involved in an accident with S1, during which R1 felt they had been purposely pushed. Assistant Administrator spoke with S1 and S1 explained that as S1 was exiting Room 39, R1 was walking past in the hallway, and they unintentionally brushed against each other. On 07/09/25 Police Officer responded to a complaint regarding an allegation that S1 had pushed R1. Upon arrival the Officer conducted interviews with all parties involved. During the interview the Officer asked R1 if they experiencing any pain or had noticed any bruising, R1 stated that they did not have any pain or bruising. Officer determinate that no further police action was warranted. Interviewed S1 stated that they accidentally brushed against R1 when S2 called S1's name and S1 steeped out from the room 39 after providing care one of the resident, and accidentally brushed against R1. S1 stated they immediately apologized. Interviewed S2 stated that they witnessed the accident that occurred on 07/07/25 between R1 and S1 and based on S2's observation the interaction appeared to be an accident. S2 stated that S1 apologized immediately to R1 and R1 responded that they knew that was an accident. Interviewed S3 stated that they didn't see that S1 or other staff pushed R1 or another resident. LPA interviewed a total of 12 residents and 11 residents stated that staff do not push residents. 11 residents stated that they did not witness any staff pushing any residents. 1 out of the 12 residents stated that S1 accidentally pushed her. Resident stated that it was an accident and they don't have any pain and bruises. Also S1 said sorry to them. Interviewed residents stated that they like the facility, they feel safe, staff treat them with respect, and they do not have any concerns. LPA toured the facility and observed residents in the patio and throughout the facility and residents appeared comfortable. LPA did not observe any bruising on any residents and did not observe anything of concern. Based on statements gathered from interviews conducted with staff, residents and LPA observations there was not enough supportive evidence to concur with the reported allegation.

Continue 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250716095553

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: 07/21/2025

NARRATIVE

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Regarding allegation: Staff does not treat residents with dignity or respect. It was alleged that S1 is a bully to a lot of the residents.

Interviewed Administrator and staff denied the allegation. They stated that staff never bully the residents and treat them with dignity and respect. Interviewed S1 stated they never bully any residents. Interviewed Assistant Administrator and staff stated that they never seen or heard that S1 bully residents. The Assistant Administrator stated they was not informed by residents that S1 or other staff bullying residents. LPA toured the facility and observed residents in the patio and throughout the facility and residents appeared comfortable. LPA observed that staff treat them with respect. LPA interviewed a total of 12 residents and residents stated that staff treat them with respect and didn't bully them. Residents interviewed also indicated they have never observed S1, or other staff members bully residents. They are content and feel safe at the facility. Based on statements gathered from interviews conducted with staff, residents and LPA observations there was not enough supportive evidence to concur with the reported allegation.

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 conducted with Assistant Administrator 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: 07/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC9099 (FAS) - (06/04)

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