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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880853
Report Date: 08/24/2021
Date Signed: 08/24/2021 10:41:01 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/29/2021 and conducted by Evaluator Christine Le
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210129114543
FACILITY NAME:MOUNTAIN VIEW PLEASANT LIVINGFACILITY NUMBER:
361880853
ADMINISTRATOR:BAUER, VIRGINIAFACILITY TYPE:
740
ADDRESS:2258 MENTONE BLVDTELEPHONE:
(909) 810-1500
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:20CENSUS: 13DATE:
08/24/2021
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Virginia 'Ginnie' BauerTIME COMPLETED:
10:50 AM
ALLEGATION(S):
1
2
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5
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9
Resident is not allowed to have phone calls
Resident is not allowed to have visitors
INVESTIGATION FINDINGS:
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9
10
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13
Licensing Program Analyst (LPA) Christine Le conducted an unannounced visit to the facility to investigate the above allegations. LPA met with administrator Ginnie Bauer.

LPA conducted interviews and reviewed files. The allegations indicate that Resident 1 (R1) is not allowed phone calls or visitors due to the resident's responsible party. During the file review and interviews, LPA was informed that R1 is conserved. R1 was in the process of obtaining legal counsel for an ongoing situation and requested to not have contact with specific individuals. During the interviews, LPA was informed that in general R1 is allowed to have phone calls and/or visitors.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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 18-AS-20210129114543
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MOUNTAIN VIEW PLEASANT LIVING
FACILITY NUMBER: 361880853
VISIT DATE: 08/24/2021
NARRATIVE
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and provided to the administrator.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2