236803448-1-27-2023-21-AS-BMOS-CP9PP8-20230221102904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 236803448
Report Date: 01/27/2023
Date Signed: 01/27/2023 12:38:20 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230106162417

FACILITY NAME:	MOUNTAIN VIEW ASSISTED LIVING		FACILITY NUMBER:	236803448
ADMINISTRATOR:	JEANETTE KINNEY		FACILITY TYPE:	740
ADDRESS:	1343 S DORA ST		TELEPHONE:	(707) 462-6212
CITY:	UKIAH	STATE: CA	ZIP CODE:	95482
CAPACITY:	64	CENSUS: 27	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Jeanette Kinney		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Licensee and/or Administrator is not responding to resident council per regulations.

INVESTIGATION FINDINGS:

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At approximately 11:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to deliver findings for the investigation into the above allegation. LPA met with Executive Director Jeanette Kinney. Based on records reviewed and interviews conducted, Executive Director did not provide responses in writing the the resident council. The responses were given verbally at a town hall meeting. LPA did not find a calendar that showed when town hall meetings were scheduled. LPA reviewed facility policy in regards to resident council and found it does not address how the facility will respond to the resident council.
Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Jeanette Kinney and Appeal rights were given.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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 21-AS-20230106162417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MOUNTAIN VIEW ASSISTED LIVING	FACILITY NUMBER: 236803448
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/17/2023 Section Cited HSC 1569.157(c)	1 2 3 4 5 6 7	§1569.157 Resident-oriented facility council:(c)If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response	1 2 3 4 5 6 7	Licensee to respond to resident council concerns or recommendations in writting within 14 calendar days. Facility to update policy regarding Resident Councils to be in line with regulation.
	8 9 10 11 12 13 14	to those concerns or recommendations within 14 calendar days. This requirement is not met as evidenced by: Based on interviews conducted, Director did not respond in writing per regulation.	8 9 10 11 12 13 14	Updated policy to be submitted to CCL by POC date of 02/17/2023.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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