198603183-5-15-2026-28-AS-DSIS-DVEV2Q-20260626160331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 05/15/2026
Date Signed: 05/15/2026 01:59:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/11/2026 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260511111735

FACILITY NAME:	COUNTRY VIEW ASSISTED LIVING		FACILITY NUMBER:	198603183
ADMINISTRATOR:	DENNISE TORRES		FACILITY TYPE:	740
ADDRESS:	824 W. CAMERON AVE		TELEPHONE:	(626) 962-3511
CITY:	W. COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	136	CENSUS: 106	DATE:	05/15/2026
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Claudia Cordoba		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are verbally abusive towards residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted an initial complaint visit to investigate the above allegations. LPA met with Wellness Director Claudia Cordoba and discussed the purpose of today's visit.

During this visit, LPA Gutierrez obtained a copy of the staff and resident rosters. LPA also obtained R1’s physician report, needs and service plan, and recent special incident reports (SIR). LPA interviewed staff #1-staff #6(S1-S6), and residents# 1-residents #9 (R2-R9). LPA Gutierrez delivered findings.

Refer to LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 28-AS-20260511111735

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COUNTRY VIEW ASSISTED LIVING	FACILITY NUMBER: 198603183
	VISIT DATE: 05/15/2026

NARRATIVE

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In regard to the allegation” Staff are verbally abusive towards residents in care”, It is alleged that staff are verbally abuse towards R1 and R2. During interview with staff six (6) out of six (6) staff all deny that staff has ever verbally abused a resident in care. S1 stated that R1 is not compliant with medications and that it may be altering their behavior. During interview with residents eight (8) out of the nine (9) residents interviewed stated that the staff treats them well. R1 stated that staff has never been verbally abusive but have done other things. R2 stated that staff has never verbally abused them but has verbally abused R1. When asked by LPA for examples R2 stated staff is mean. LPA Gutierrez observed staff conducting care and supervision to residents and did not observe staff verbally abusing residents.

“Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was given to Claudia Cordoba.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC9099 (FAS) - (06/04)

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