<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 05/08/2026
Date Signed: 05/08/2026 08:49:49 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
02/23/2026 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260223153823
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:
05/08/2026
UNANNOUNCEDTIME BEGAN:
08:03 PM
MET WITH:Tara Lafez TIME COMPLETED:
09:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit resident resulting in a bruise.
Staff do not provide a comfortable room temperature for resident(s).
Staff cancel resident’s appointments.
Staff disrupt resident’s sleep due to loud music.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 05/08/2026 regarding the above allegations and delivered findings. On 03/02/2026, LPA conducted initial complaint investigation visit and a need further investigation was documented. During today’s visit LPA Ramirez was greeted by Tara Lafez and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 4 interviews (S1 – S4), copy of resident#1 (R1) emergency contact information, Medication Administration Record (MAR), signed statements by S1,S2, and S3, and physical plant tour.

SEE 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
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-20260223153823
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: 05/08/2026
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 “Staff hit resident resulting in a bruise.” It is alleged that one year ago, staff#1 (S1) hit resident#1 (R1) on their elbow, which resulted in R1’s sustaining a bruise. In July of 2025, this Department investigated the allegation: “Staff member pushed resident in care causing an injury”, which involved S1 and R1. Upon investigation, the Department concluded the allegation was Unsubstantiated.

The investigation revealed regarding: “Staff hit resident resulting in a bruise” Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. Interview with R1 revealed that R1 was walking in the hallway when S1 hit R1 with S1’s arm. R1 revealed that S1 was backing up with both of their hands on a cleaning cart when S1’s arm came into contact with R1’s elbow, which resulted in R1’s obtaining a bruise. R1 revealed that no words were exchanged prior to this incident. Four (4) out of the four staff interviewed denied this allegation. Interview with S1 revealed that S1 was backing out of another resident’s room with a cart and accidentally bumped into R1. S1 revealed that S1 immediately apologized to R1. S1 revealed that R1 did not fall or shout in pain after S1 bumped into R1. Interview with S3 revealed that witnessed S1 walking out of another resident’s room with a cart and accidentally “bump” into R1. S3 revealed they saw S1 immediately apologize and ask R1 if they were okay. S3 revealed they also approached R1 to check on them and reassured R1 it was an accident. S3 revealed that R1 acknowledged S1 accidentally bumped into R1. S3 denied that R1 complained of pain or injury immediately after the incident. Review of R1’s Unusual Injury/ Incident Reports (LIC 624) did not corroborate this allegation. Review of statements signed by S1, S2 and S3 did not corroborate 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.

“Staff do not provide a comfortable room temperature for resident(s).” It is alleged that staff do not turn on the heater when it’s cold outside. Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. Interview with R1 revealed they have requested staff turn on the heater so R1’s room will be warm. R1 revealed staff do not turn the heater on and their room is too cold. During facility on 03/02/2026, LPA observed facility thermostat read 77 degrees at 9:15am. During tour of R1’s room, LPA observed R1’s ac/heating air went, covered with white cardboard and tape. R1 revealed they do not want the vent open and wish to keep it taped up. LPA observed a space heater and portable fan in R1's room. During tour of TV room and activity room, LPA did not observe residents to be shivering or bundled up with multiple layers of blankets or clothing. 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. SEE 9099-C

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20260223153823
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: 05/08/2026
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
“Staff cancel resident’s appointments.” It is alleged that staff cancel R1’s medical appointments. Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. Interview with R1 revealed that they had mail to prove that staff cancel R1’s doctor appointments without R1’s consent. LPA requested R1 to provide mail proof that staff canceled R1’s medical appointment. R1 denied LPA’s request. Review of R1’s Identification and Emergency Information revealed that R1 is self-responsible. Staff interviews revealed that R1 makes their own medical appointments and staff is not aware when R1 makes medical appointments. LPA attempted to contact R1’s medical provider but all attempts were unsuccessful. 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.

“Staff disrupt resident’s sleep due to loud music.” It is alleged that staff play loud music at night and R1 is unable to sleep. Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. On 5/8/2026, at 8:01pm, LPA Ramirez did not observe staff playing music. LPA observed residents in various areas of the facility watching TV and conversating amongst other residents. Resident interviews revealed that staff will play music during resident karaoke, but this happens in the daytime, and the music is not very loud. 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.

No deficiencies were cited. Exit interview was conducted. A copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3