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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312701011
Report Date: 05/05/2025
Date Signed: 05/05/2025 04:05:55 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/12/2024 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 59-AS-20241112100310
FACILITY NAME:MOUNTAIN VIEW SENIOR CARE, LLCFACILITY NUMBER:
312701011
ADMINISTRATOR:JACKSON, SAYEHFACILITY TYPE:
740
ADDRESS:3755 MOUNTAIN VIEW DRTELEPHONE:
(916) 893-3099
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:0CENSUS: 0DATE:
05/05/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:e-mailed via certified mail TIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure residents incontinence care needs were being met.
Staff did not ensure residents records were properly maintained.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This facility is currently closed therefore this report is being sent to the licensee via email and certified Mail.

The department conducted records review ,facility observations and interviews to investigate the complaint.



**Report continued on LIC9099-C**
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2025
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 2
Control Number 59-AS-20241112100310
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MOUNTAIN VIEW SENIOR CARE, LLC
FACILITY NUMBER: 312701011
VISIT DATE: 05/05/2025
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
**report continued from 9099.....

Allegation- Staff did not ensure residents incontinence care needs were being met.

The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with three (3) facility staff and three (3) residents, it has been discovered that facility was providing appropriate care to the residents based on resident’s documented needs and service plans. During department visit on 02/20/25, department observed that staff were attentive to resident’s care needs and helping them with their care needs. Staff interviews reflected that facility provide adequate staffing and there were no issues with staff not helping residents with their care needs. Staff stated that they were assisting residents with toileting needs every 2 hours or as needed. Hospice staff interview disclosed that there was no care concerns were noted during R1s stay at facility. Resident’s interviews indicated their satisfaction with their care needs including toileting, dental, showers and other care needs and did not express any concerns in this area, therefore this allegation is UNFOUNDED.

Allegation- Staff did not ensure residents records were properly maintained.

During investigation, the Department interviewed three (3) residents and three (3) staff and reviewed records to investigate this allegation. Record review indicated that facility kept proper documentation regarding resident, R1s admission agreement, hospice care plan and other required components regarding R1’s care per Department’s Regulations. Resident’s interviews reflected that facility was meeting their care needs per their needs and service plan and per admission agreements and there were no problems. Staff interviews indicated that they were aware about residents’ care needs per their needs and service plan and providing care accordingly. Interview with hospice agency regarding resident, R1s care did not reflected any care concerns or any issues with R1s records while R1 resided at the facility. Based on gathered information, this allegation was found to be UNFOUNDED.

A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Copy of this report was sent to Licensee via certified mail and email.

Licensee is requested to sign and return report to department.


SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2