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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604087
Report Date: 10/25/2023
Date Signed: 10/25/2023 11:32:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/18/2023 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20231018124633
FACILITY NAME:MOUNTAIN VIEW HOME-DEL VISTA WAYFACILITY NUMBER:
374604087
ADMINISTRATOR:RUSSELL, KATRINAFACILITY TYPE:
735
ADDRESS:16350 DEL VISTA WAYTELEPHONE:
(619) 419-9938
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:4CENSUS: 2DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Katrina Russell, AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff engaged in a verbal altercation with resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegation. LPA identified herself and met with Katrina Russell Adminstrator, to discuss the purpose of the visit and elements of the complaint.

It was alleged that staff engaged in a verbal altercation with resident in care. The Department's investigation included interviews and review of pertinent records. On October. 17, 2023 Staff 1 (S1) picked Client 1 (C1) up from the hosptial. Interviews revealed while S1 was transporting C1 they received a call from an outside source. Interviews revealed while C1 was talking on the phone that C1 and S1 didn't agree on C1 going somehwere that day due to C1 just getting out of the hospital.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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 08-AS-20231018124633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MOUNTAIN VIEW HOME-DEL VISTA WAY
FACILITY NUMBER: 374604087
VISIT DATE: 10/25/2023
NARRATIVE
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 Interviews revealed that C1 and S1 started speaking loudly while on the phone with the outside source. After interviewing C1 and S1, interviews revealed that they did have a disagreement about C1 going out into the community after being released from the hospital but they did not have a screamfest or verbal altercation with each other. Interviews revealed they are always able to talk things out and can agree to disagree. Interviews revealed they both are loud people and they talk loud especially when excited or trying to get their point across. The allegation of staff engaged in a verbal altercation with resident in care is unsubstantiated.

An exit interview was conducted with Katrina Russell Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2