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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604087
Report Date: 08/20/2025
Date Signed: 08/20/2025 03:10:24 PM

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
10/04/2021 and conducted by Evaluator Angelica Boyles
COMPLAINT CONTROL NUMBER: 08-AS-20211004083922
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:
08/20/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Administrator Katrina RussellTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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9
Staff neglected clients leading to client on client abuse.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Administrator Katrina Russell.

On October 4, 2021 the Department received this complaint which alleged staff neglected clients leading to client on client abuse. The Department’s investigation included a facility tour, record reviews, and interview with staff.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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-20211004083922
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: 08/20/2025
NARRATIVE
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(Continued from LIC9099)

The Department received an incident report submitted by the facility on October 3, 2021 regarding the client on client incident reported from the allegation. Per the submitted report, on October 2, 2021 Client #1 (C1) kicked Client #2 (C2) in the leg and then hit C2 in the face [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] Per the report, facility staff had visual contact with the clients and immediately separated clients. Interview with staff corroborated that staff were present and followed proper protocol in separating clients. Per records reviewed, the facility submitted reports to all appropriate parties and agencies regarding this incident.

The Department has investigated the allegation that staff neglected clients leading to client on client abuse. Based upon the information obtained during this investigation, there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated.

An exit interview was conducted with Administrator Katrina Russell, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2