366409921-6-28-2023-18-AS-KCLS-CT9SS8-20230629140729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366409921
Report Date: 06/28/2023
Date Signed: 06/28/2023 03:29:29 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/01/2021 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210201140614

FACILITY NAME:	MOUNTAIN VIEW RESIDENTIAL CARE		FACILITY NUMBER:	366409921
ADMINISTRATOR:	ILAGAN, ALEXANDER		FACILITY TYPE:	740
ADDRESS:	9073 OLIVE ST		TELEPHONE:	(909) 822-5174
CITY:	FONTANA	STATE: CA	ZIP CODE:	92335
CAPACITY:	24	CENSUS: 23	DATE:	06/28/2023
		ANNOUNCED	TIME BEGAN:	03:22 PM
MET WITH:	Channe Carlos, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident was inappropriately touched while in care.
Staff did not properly safeguard the facility.
Staff did not properly report incidents involving residents while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas met with Administrator Channe Carlos in the Riverside/San Bernardino Regional Office to deliver findings on the above allegations. Department staff investigated these allegations, and LPA Nickolas’ requested additional information and a facility file review pertinent to this investigation.

Allegation #1 “Resident was inappropriately touched while in care”. The allegation alleged that resident #1 (R1) was fondled during a break-in. Department staff interview with R1 revealed that R1 was sleeping at the time, and the unknown perpetrator touched their leg. R1 stated that this incident was reported to staff, and staff reported this incident to the police. Department staff interview with resident #3 (R3) revealed that R3 shares a room with R1. R3 stated that they were sleeping and did not witness the incident. Department staff interview with staff #2 (S2) revealed that on February 1, 2021, an unidentified perpetrator touched R1’s leg. S2 stated that the police were notified, and the police arrived right away. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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 18-AS-20210201140614

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
, CA 92507

FACILITY NAME: MOUNTAIN VIEW RESIDENTIAL CARE	FACILITY NUMBER: 366409921
	VISIT DATE: 06/28/2023

NARRATIVE

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Allegation #2 “Staff did not properly safeguard the facility”. The allegation alleged that a few weeks ago, the facility suffered a break-in, and items were stolen from residents. The allegation alleged that the facility’s administrator assured the reporting party (RP) that a security system and the appropriate door locks would be installed immediately. The allegation alleged that the facility was broken into again, additional items were stolen from residents, and the residents still do not have locks on their doors. Department staff interview with R1 revealed that the intruder entered R1’s room on two (2) separate occasions. R1 stated they could not lock their door because the door latch was broken, preventing them from locking the door. However, R1 acknowledges that the door lock was fixed on February 9, 2021, and Department staff also confirmed that the lock and latch were fixed. Department staff interview with resident #2 revealed that R2 confirmed an intruder in the facility, and their items were stolen. R2 confirmed that they have a lock on their door and that the facility has installed additional locks. Department staff interviews with several facility staff members revealed that all staff interviewed confirmed the break-in and that resident’s items were stolen. However, all staff denied the allegation that the facility did not safeguard the residents' property. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #3 “Staff did not properly report incidents involving residents while in care”. The allegation alleged that the facility intimidates staff and residents from reporting issues. Department staff interview with the RP revealed that the facility failed to notify them about the break-ins. The RP stated they learned about the break-ins through a family member at the facility. Department staff interview with the administrator revealed that facility staff contacted the police and filed a report. The administrator stated that an incident was faxed to Community Care Licensing Division (CCLD). LPA Nickolas’ cannot attest whether the facility faxed an incident report to CCLD when this allegation was made.The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

LPA Nickolas completed an exit interview, where this report was discussed. LPA Nickolas' also provided Carlos with a copy of this report.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC9099 (FAS) - (06/04)

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