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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 07/31/2025
Date Signed: 07/31/2025 05:00:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
07/24/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250724161346
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: 117DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dennise Torres, Assistant AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff member pushed resident in care causing injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced and met with Dennise Torres, the Assistant Administrator. The purpose of the visit was explained.

LPA obtained a copy of the staff and resident roster, reviewed documents for Resident #1, and interviewed Staff #1 - #5 and Residents #1 – 10.

The investigation revealed the following:
Allegation - Staff member pushed the resident in care, causing injury. It is alleged that Staff #1 (S1) pushed Resident #1 (R1), causing a bruise on the right elbow. LPA interviewed five (5) staff regarding this allegation. S1 denied pushing R1 and stated that the incident was accidental. Another staff who witnessed the incident also deemed the incident to be accidental.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
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 2
Control Number 28-AS-20250724161346
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: COUNTRY VIEW ASSISTED LIVING
FACILITY NUMBER: 198603183
VISIT DATE: 07/31/2025
NARRATIVE
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It was described that S1 was backing out of a resident’s room and unintentionally brushed against R1. S1’s hands were on the supply cart at the time of the incident, and did not push R1 as alleged on 7/7/25. R1 did not fall or mention any pain. Staff immediately apologized when contact was made. Staff interviewed stated the police responded to this situation on 7/9/25 and interviewed the resident and staff. The police determined there was no further action warranted as the incident was deemed accidental and no injuries were observed.

LPA interviewed ten (10) residents, and eight (8) feel safe residing at the facility. Eight (8) of the residents have not witnessed any staff pushing a resident and feel that the staff treat them well and are respectful. One (1) resident interviewed feels that staff are targeting them and does not feel safe at the facility. Interview with R1 revealed that the incident could have been accidental and that S1 had apologized. R1 stated the bruise was observed a few days later, and cannot be certain that it derived from the prior incident. Based on the information gathered, there is insufficient evidence to support this allegation.

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, was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
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