236803448-10-21-2021-21-AS-BMOS-C8LPCR-20211109101222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 236803448
Report Date: 10/21/2021
Date Signed: 10/21/2021 01:15:30 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/05/2021 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20211005164845

FACILITY NAME:	MOUNTAIN VIEW ASSISTED LIVING		FACILITY NUMBER:	236803448
ADMINISTRATOR:	SMITH, ANGIE		FACILITY TYPE:	740
ADDRESS:	1343 S DORA ST		TELEPHONE:	(707) 462-6212
CITY:	UKIAH	STATE: CA	ZIP CODE:	95482
CAPACITY:	64	CENSUS: 35	DATE:	10/21/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Angie Smith		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff yelled at resident in care.

INVESTIGATION FINDINGS:

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At approximately 8:30AM, Licensing Program Analyst Chris Arnhold arrived to this facility unannounced to continue an investigation into the above allegation. LPA met with Executive Director Angie Smith. During the course of this investigation, LPA interviewed staff and residents, reviewed records and received copies of documents. Based on interviews conducted, there was no supporting information to support the allegation that staff yelled at a resident. The staff member that was alleged to have yelled at resident has worked at the facility since 2002 and has no disciplinary items in their file. LPA conducted interviews with other staff who were on duty at the alleged time of the incident. Staff reported they did not hear a staff yell or raise their voice at a resident.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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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