361800015-8-4-2023-56-AS-NBRN-CVTUDD-20230919152923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800015
Report Date: 08/04/2023
Date Signed: 08/04/2023 04:09:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230802121927

FACILITY NAME:	MOUNTAIN VIEW COTTAGES VII		FACILITY NUMBER:	361800015
ADMINISTRATOR:	JASBINDAR SINGH		FACILITY TYPE:	740
ADDRESS:	917 EAST MESA DRIVE		TELEPHONE:	(909) 566-4000
CITY:	RIALTO	STATE: CA	ZIP CODE:	92376
CAPACITY:	6	CENSUS: 5	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Helen Nova, Caregiver		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff do not assist resident with ambulating.
Facility has pests.
Staff speak inappropriately to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Mountain View Cottages VII Facility unannounced to initiate a complaint investigation into the allegations listed above. LPA rang doorbell, Caregiver answered the door, greeted LPA and granted entry. LPA introduced self and stated purpose of the visit. Staff identified themselves as Helen Nova, then contacted Administrator, Jasbinder Singh who arrived to the visit shortly there after. Today's visit included, gathering pertinent documents, review of staff, facility and resident files, staff and resident interviews and a walk through the facility in and out.

It is alleged that staff do not assist residents with ambulating. During staff interviews, it was discovered that the residents are relatively independent and rarely ask for assistance. According to resident files, the facility cares for residents with memory impairment and mild cognitive impairment. Resident interviews revealed that resident's who need assistance ask or call out for help. Assistance comes in a timely manner. Residents report staff members do offer help to the residents, on a regular basis.
Please see LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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 56-AS-20230802121927

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MOUNTAIN VIEW COTTAGES VII	FACILITY NUMBER: 361800015
	VISIT DATE: 08/04/2023

NARRATIVE

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It is alleged that the facility has pests. LPA toured the facility in and out and made no observations of pests; or evidence of a pest control problem. LPA did tour resident rooms and observed that residents do keep open containers of food in their rooms. Staff interviews revealed that they see pests, but not very often as the staff regularly spray the facility with pesticides; both inside and outside. Residents shared that they may have seen a few insects, but not enough to say it is an issue, because staff spray.

It is alleged that staff speak to residents inappropriately. During staff interviews, LPA observed that staff do have heavy accents. All staff denied experiencing difficulty speaking to residents. Staff denied ever speaking to or having knowledge of staff speaking inappropriately to one another. All residents, deny witnessing any staff speak to residents inappropriately.

Based on observations, interviews and review of records, we have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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