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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604087
Report Date: 05/22/2024
Date Signed: 05/22/2024 10:16:47 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
10/25/2023 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20231025123703
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: 1DATE:
05/22/2024
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Katrina Russell, AdministratorTIME COMPLETED:
10:25 AM
ALLEGATION(S):
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Licensee does not provide planned activities for clients
Staff do not assist client with obtaining medical care
Licensee does not provide adequate food services for clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to deliver investigation f indings regarding the above-mentioned allegations. LPA identified herself and met with Katrina Russell Adminstrator, to discuss the purpose of the visit and elements of the complaint.

The Department's investigation included interviews and review of pertinent records. It was alleged that the licensee does not provide planned activities for clients. Interviews revealed there are several things to do around the facility. There are games and outside activities for the clients to engage in. Interviews revealed the staff take clients on outings in the community. Interviews revealed the clients like to stay in their rooms and watch television or play video games.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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-20231025123703
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: 05/22/2024
NARRATIVE
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It was alleged that staff do not assist client with obtaining medical care. Interviews revealed the clients all get taken to their appointments and that the administrator or other staff members are the ones that make all appointments. Interviews revealed the clients are taken in to the physicals and psych/mental health appointments after the appointments have been made. Interviews revealed the facility has logs of when the clients go to their appointments and that the documents are all logged. Interviews with clients revealed the staff make the appointments and they also take them to the appointments.

It was alleged that the licensee does not provide adequate food services for clients. Interviews revealed the clients eat nutritious and well balanced meals that have a meat, vegetable and some type of starch. Interviews revealed the clients have home cooked meals. Upon LPAs observations there was food in the pantry and in the refrigerator and freezer. There were plenty of snacks and some frozen food. Interviews revealed there are frozen burritos for the clients to eat for a quick snack. The clients request the burritos, interviews revealed that they do not have the burritos for dinner. Interviews with clients revealed they eat really good food and they have homemade meals when the staff cook.

The allegations of licensee does not provide planned activities for clients, staff do not assist client with obtaining medical care, and licensee does not provide adequate food services for clients are 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: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2