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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366409921
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:28:26 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
06/01/2021 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210601154523
FACILITY NAME:MOUNTAIN VIEW RESIDENTIAL CAREFACILITY NUMBER:
366409921
ADMINISTRATOR:ILAGAN, ALEXANDERFACILITY TYPE:
740
ADDRESS:9073 OLIVE STTELEPHONE:
(909) 822-5174
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:24CENSUS: 24DATE:
10/20/2023
UNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Nenita "Joney" CarlosTIME COMPLETED:
02:34 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility not providing adequate cleaning services to resident rooms.
Staff yell at residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Anna Bueno, Magda Malcore, and Bianca Wolcott conducted a subsequent unannounced visit to the facility to continue the investigation the above mentioned complaint allegations and deliver findings. LPAs identified themselves to staff who was informed of the reason for today’s visit and contacted licensee Nenita Carlos. The Department investigation included staff and resident interviews and facility inspections.

Allegation 1: Facility not providing adequate cleaning services to resident rooms. Staff interviews reveal that resident rooms are cleaned as needed or requested by residents and are also cleaned on a weekly schedule. During unannounced LPA inspection of resident bedrooms, LPAs observed that rooms are kept tidy according to resident preference and LPAs observed facility staff cleaning rooms.
Allegation 2: Staff yell at residents. Interviews with residents reveal that staff do not yell at residents and staff interviews deny that they yell at residents. The Department was not able to interview Resident 1 (R1).

Based on the information obtained during the investigation, the allegations are therefore UNSUBSTANTIATED. A finding of unsubstantiated means that, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was reviewed with and a copy was provided to Joney Carlos.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
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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