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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 295001794
Report Date: 02/18/2022
Date Signed: 02/18/2022 03:47:02 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2022 and conducted by Evaluator Jacob Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220211121839
FACILITY NAME:MOUNTAIN VIEW CARE HOMEFACILITY NUMBER:
295001794
ADMINISTRATOR:BRITTANY ALLEYFACILITY TYPE:
740
ADDRESS:10619 SIERRA DRIVETELEPHONE:
(530) 273-7820
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 13DATE:
02/18/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brittany Alley, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff are not wearing mask per COVID-19 guidelines
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jacob Williams arrived unannounced to deliver findings to a complaint received on 02/11/2022. LPA met with Brittany Alley, Administrator, and explained purpose of visit. Prior to initiating today's visit, LPA completed required COVID-19 testing protocols, confirmed there are currently no positive Covid-19 diagnoses, and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Respirator.

During the course of the investigation, LPA interviewed the Administrator, contacted Long Term Care Ombudsman (LTCO) and observed two staff working in facility. The results of the investigation are as follows:

Cont on 9099-C..
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
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 5
Control Number 25-AS-20220211121839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MOUNTAIN VIEW CARE HOME
FACILITY NUMBER: 295001794
VISIT DATE: 02/18/2022
NARRATIVE
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Allegation: Staff are not wearing mask per COVID-19 guidelines. LPA observed two (2) staff working in facility at time of visit. Of those staff, neither were wearing masks. Pin 21-38-ASC issued on 08/21/2021 states All ASC residential facilities must strictly adhere to current CDPH Masking Guidance:
  • Masks are required for all individuals in the following indoor settings, regardless of vaccination status: Long Term Care Settings & Adult and Senior Care Facilities


Note: Administrator was notified of LPA's arrival and came downstairs to meet with LPA. Prior to entering the facility, Administrator was sure to put on her own surgical mask. Administrator stressed that it is a Mountain View Care Home facility policy that staff are wearing masks at all times while caring for residents. Administrator spoke with staff during time of visit regarding wearing masks while inside facility.

Based on information obtained, the Department finds the portion of the allegation pertaining to clients to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Based on California Code of Regulations, Title 22, Division 6, Chapter 8, one (1) deficiency is being cited.

Exit interview conducted with Administrator. Appeal rights provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2022 and conducted by Evaluator Jacob Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220211121839

FACILITY NAME:MOUNTAIN VIEW CARE HOMEFACILITY NUMBER:
295001794
ADMINISTRATOR:BRITTANY ALLEYFACILITY TYPE:
740
ADDRESS:10619 SIERRA DRIVETELEPHONE:
(530) 273-7820
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 13DATE:
02/18/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brittany Alley, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff are not ensuring visitors follow COVID-19 guidelines
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jacob Williams arrived unannounced to deliver findings to a complaint received on 02/11/2022. LPA met with Brittany Alley, Administrator, and explained purpose of visit. Prior to initiating today's visit, LPA completed required COVID-19 testing protocols, confirmed there are currently no positive Covid-19 diagnoses, and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Respirator.

During the course of the investigation, LPA interviewed the Administrator, contacted Long Term Care Ombudsman (LTCO) and reviewed documentation including: visitor check-in screening logs.

The results of the investigation are as follows:

Cont on 9099-C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 25-AS-20220211121839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MOUNTAIN VIEW CARE HOME
FACILITY NUMBER: 295001794
VISIT DATE: 02/18/2022
NARRATIVE
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Allegation: Staff are not ensuring visitors follow COVID-19 guidelines. LPA reviewed staff and visitor temperature logs, which were present at entry door. LPA reviewed resident temperature logs and observed they have been filled out with name and temperature. LPA also noticed an automatic thermal thermometer for each visitor to take their own temperature upon entry. Administrator stated she bought the standing automatic thermal thermometer because her smaller thermometer kept getting stolen by residents. LPA gave Administrator a portable thermal thermometer to keep in case she has an issue with her current set-up.

Based on information obtained, the Department finds the portion of the allegation pertaining to clients to be UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 25-AS-20220211121839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: MOUNTAIN VIEW CARE HOME
FACILITY NUMBER: 295001794
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2022
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidenced by:
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During this same visit on 2/18/2022 LPA Williams witnessed Administrator speak with staff and notify them that they are required to wear face masks at all times while in the faciliy. All staff in the facility immediately put on masks as soon as LPA Williams informed them of the regulations.
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Based on observation of staff, the facility staff are not wearing masks while inside of facility, which posed a potential health and safety risk to clients in care.
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This deficiency was corrected during LPA visit on 2/18/2022.
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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: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5