366423658-5-12-2023-56-AS-NBRN-CRWNSM-20230517104321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423658
Report Date: 05/12/2023
Date Signed: 05/12/2023 01:59:14 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
05/08/2023 and conducted by Evaluator Amber Coleman

COMPLAINT CONTROL NUMBER: 56-AS-20230508165247

FACILITY NAME:	MOUNTAIN VIEW COTTAGES-VIII		FACILITY NUMBER:	366423658
ADMINISTRATOR:	MODY, TRUPTI		FACILITY TYPE:	740
ADDRESS:	9779 RAMONA AVE		TELEPHONE:	(909) 625-1231
CITY:	MONTCLAIR	STATE: CA	ZIP CODE:	91763
CAPACITY:	6	CENSUS: 5	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Harjinder Kaur, Staff Member		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Staff do not have the ability to communicate with residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Mountain View Cottages VIII Facility, unannounced to initiate a complaint investigation into the allegations above. LPA introduced self to staff upon arrived, introduced self and stated purpose of the visit. LPA was greeted and granted entry by staff member Harijinder Kaur, who took LPA's temperature and requested LPA sign in. Ms. Kaur contacted, the Administrator and gave LPA the phone. LPA introduced self and stated purpose of the visit.

Today's visit consisted of collection of pertinent documents, staff and resident file reviews and interviews of staff and residents. Staff reported the current census is five (5). Two, (2) residents were out walking the neighborhood for exercise.

It is alleged that staff do not have the ability to communicate with resident in care. During staff interviews, LPA had no difficulty communicating to staff during interviews. Interviews with staff indicated that there are 2 staff members who live on facility grounds. The two of them work 5 days on and 2 days off. A third staff member works 7am to 3pm, 4 days a week.

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: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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-20230508165247

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-VIII	FACILITY NUMBER: 366423658
	VISIT DATE: 05/12/2023

NARRATIVE

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All staff deny having any problems communicating with one another or with residents in care. The Administrator makes a visit to the facility everyday. In the event she is needed, staff contact her and within the hour she makes herself available for the needs of the facility. LPA did not experience any problem communicating with the Administrator.

Interviews with residents revealed that no resident had any challenges communicating with staff. No resident indicated that staff have challenges communicating with them. Residents report when staff's assistance is needed they call out for assistance and experience no problem getting staff's attention and receiving assistance in a timely manner. LPA observed interaction between residents and staff. LPA made no observation of staff and residents experiencing difficulty communicating with one another.

LPA reviewed three, (3) staff files. Three (3) out of 3 staff files contained all completed documents per regulation.

Based on information above, these allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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.

An exit interview was conducted, this report was reviewed, discussed, then provided to facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC9099 (FAS) - (06/04)

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