374604087-9-15-2025-08-AS-SJAB-DLSTTS-20250923150111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604087
Report Date: 09/15/2025
Date Signed: 09/15/2025 03:14:10 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
10/05/2021 and conducted by Evaluator Angelica Boyles

COMPLAINT CONTROL NUMBER: 08-AS-20211005104230

FACILITY NAME:	MOUNTAIN VIEW HOME-DEL VISTA WAY		FACILITY NUMBER:	374604087
ADMINISTRATOR:	RUSSELL, KATRINA		FACILITY TYPE:	735
ADDRESS:	16350 DEL VISTA WAY		TELEPHONE:	(619) 419-9938
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	4	CENSUS: 2	DATE:	09/15/2025
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Administrator Katrina Russell		TIME COMPLETED:	03:23 PM

ALLEGATION(S):

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Improper placement resulting in unsafe environment for clients in care
Licensee is falsifying incident reports

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Angelica Boyles and Janet Ngallo conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegations. LPAs identified themselves, explained the purpose of the visit and nature of the complaint to Administrator Katrina Russell.

On October 5, 2021 the Department received this complaint which alleged improper placement resulting in unsafe environment for clients in care and licensee falsifying incident reports. The Department’s investigation included a facility tour and a review of records.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

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 08-AS-20211005104230

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: 09/15/2025

NARRATIVE

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(Continued from LIC9099)

Regarding the allegation that improper placement resulted in unsafe environment for clients, an outside agency is responsible for placing clients. The outside agency reviews client files prior to placement to determine if the client is well fitted for the facility.

Regarding the allegation that licensee falsifying incident reports, records reviewed did not produce evidence of the alleged documentation being falsified. Further, staff and clients were not interviewed at the time of the allegation and no longer work or live at the facility therefore unable to provide a statement.

The Department has investigated the allegations that improper placement resulting in unsafe environment for clients in care and licensee falsifying incident reports. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed 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: 09/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

LIC9099 (FAS) - (06/04)

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