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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 12/16/2025
Date Signed: 12/16/2025 03:42:22 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
12/11/2025 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20251211111341
FACILITY NAME:COUNTRY VIEW ASSISTED LIVINGFACILITY NUMBER:
198603183
ADMINISTRATOR:DENNISE TORRESFACILITY TYPE:
740
ADDRESS:824 W. CAMERON AVETELEPHONE:
(626) 962-3511
CITY:W. COVINASTATE: CAZIP CODE:
91790
CAPACITY:136CENSUS: 111DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Claudia Cordoba - Wellness DirectorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff do not ensure residents are accorded dignity and respect in their personal relationships by other adults in the facility.
Staff do not ensure residents receive their mail correspondences in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Claudia Cordoba. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained.

The investigation consisted of the following: LPA Margaryan requested Staff and Residents rooster, conducted interviews with Administrator, Staff 1 to Staff 3 (S1 to S3) and Resident 1 to Resident 11 (R1 to R11). LPA attempted to interview R12 over the phone. R12's phone number was disconnected.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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 3
Control Number 28-AS-20251211111341
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: 12/16/2025
NARRATIVE
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Regarding the allegation: Staff do not ensure residents are accorded dignity and respect in their personal relationships by other adults in the facility. It was alleged that R8 slams the door hard and messes up the reception on the TV in RP’s room and R9 told RP “You don’t belong here, and you should leave.” RP got into verbal confrontations with residents and staff won’t do anything about the residents being disrespectful to each other.

Interviewed Administrator and staff stated that they ensure residents speak to each other with respect and dignity. Administrator stated whenever a complaint regarding residents is received, staff immediately address the situation by speaking with the involved residents to ensure concerns are discussed, resident comfort is maintained, and appropriate steps are taken. Interviewed staff stated that if there is any confrontation between residents, they first calm them down, listening to their concern and trying to find a solution and will notify Administrator about the incident. Interviewed Administrator stated that several months ago one of the residents, R12, reported that R7 would bang on the walls and that effect on the TV reception in R12’s room. Administrator stated that they spoke with R7 which denied the allegation. To prevent further escalation and to ensure resident comfort, R7 was relocated. Recently R12 reported similar concern regarding their current neighbor, R8 indicating wall banging. R8 also denied that they bang on the wall. R12 and R8 were offered to relocate rooms, both have declined. Interviewed R7 and R8 stated they never bang the wall or slammed the door. Interviewed Administrator and staff stated that they didn't hear or witnessed that R9 tell resident(s) “You don’t belong here, and you should leave.” Interviewed Residents stated they get along with each other, sometimes there are disagreements between residents, but staff will speak with residents and will make sure they are respectful to each other. Interviewed residents stated they didn’t get into verbal confrontations with other residents and didn’t hear that any resident tell another resident “You don’t belong here, and you should leave.” Interviewed R9 stated that they never tell anyone “You don’t belong here, and you should leave.”

Continue 9099C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20251211111341
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: 12/16/2025
NARRATIVE
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Regarding the allegation: Staff do not ensure residents receive their mail correspondence in a timely manner. It was alleged that staff don’t make sure residents receive their mail.

Interviewed Administrator and staff denied the allegation. Administrator stated that residents mail is distributed daily, depending on the time it arrives. Staff will sort the mail and then distribute it in the dining room or residents rooms, or residents are paged to the front desk if they cannot be located in these areas. Interviewed administrator and staff stated there are assigned staff to pass the mail on a daily basis. The only time mail is not delivered to the residents is when the residents are out of the facility or in the hospital. Staff will hold the mail for them until they return. interviews with residents did not corroborate the allegation. They stated that they received their mail in a timely manner, delivered by facility staff and have had no issues in obtaining their mail.

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 is conducted and the copy of this report was provided to Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3