Mountain View Cottages - IV

Allegation investigated: Staff did not maintain a comfortable temperature for residents in care. Physical plant is in disrepair.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced and met with Staff, Elly Norsati. The purpose of the visit was explained. Administrator Jas Singh was informed of the visit via telephone. LPA toured the facility and interviewed two (2) staff and three (3) residents. The investigation revealed the following: Allegation – Staff did not maintain a comfortable temperature for residents in care. It is alleged that the house thermometer read at 97 degrees F on 8/1/26. LPA interviewed staff and residents regarding this allegation. Staff stated that there is a window air conditioner in each resident room but no central air conditioning. Staff stated that the residents appear comfortable with the indoor temperature. The house thermostat read at 90 degrees F during the visit today. Substantiated LPA interviewed three (3) residents, and they stated they are okay with the temperature in the house. However, a resident (Resident #1 - R1) was transported to the hospital earlier this month and was diagnosed with dehydration. LPA was unable to interview R1 as the resident is non-verbal. Staff stated that they cannot tell if R1 was comfortable or not since the resident is unable to express their needs. Based on information obtained, this allegation is substantiated. Allegation - Physical plant is in disrepair. It is alleged that the air conditioner is not working. LPA interviewed staff who acknowledged that the air conditioner in one of the residents’ rooms is not working. Two (2) out of the three (3) residents interviewed stated the air conditioners in their rooms work. LPA tested the wall air conditioner units in the three resident rooms, and (2) were not working properly. One did not turn on, and the other was not blowing out cool air. Therefore, the allegation is substantiated. Based on LPA observations and interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Aug 7, 2026 · control 28-AS-20260803153029

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(b)(2) · Plan of correction due date: Aug 8, 2026

87303 Maintenance and Operation(b) A comfortable temperature for residents shall be maintained...(2)The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C)... This requirement is not met as evidenced by: Based on interviews and observations, the faciity's indoor was measured at 90 degrees F and resident went to the hospital for dehydration which posed a immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: The licensee shall ensure the facility temperature is at a comfortable range, between 78 and 85 degrees F. A plan to ensure the temperature will stay in the range shall be submitted to LPA by 8/8/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 14, 2026

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interviews, 2 out of the 3 resident rooms do not have air conditioners properly working which poses a potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: The licensee shall ensure that all air conditioning units in the facility are working properly. The licensee shall submit proof of installation of new air conditioners or air conditioners in working order by POC due date 8/14/26.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vaid conducted an unannounced Annual Required 1-year visit. Staff person Fiviyanti Lo allowed entry into facility. LPA was met by Administrator Jasbindar Singh and explained the purpose of the visit. The facility is licensed to serve six (6) non ambulatory residents over the age of 60 and has an approved hospice waiver for four (4). Currently one(1) resident is under hospice. The visit consisted of the completion of CARE tool, interviews of staff/residents, conduct of physical plant, and reviews of food supply/ medications/ facility records. Physical Plant: The facility is a single-story dwelling located on a main street with three (3) resident bedrooms, two (2) staff bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Front yard was clean and well maintained. LPA Vaid observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Vaid observed knives and sharps located in kitchen cabinet, to be inaccessible to residents in care. Kitchen sink water temperature was measured at 114.2 degrees F. Kitchen appliances were observed to be clean and in working order. Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Interior temperature measured at 78 degree F. Backyard was clean and well maintained. Plenty of shade and seating was observed. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms : LPA Vaid inspected three (3) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. CONTINUED ON PAGE 809C.......... Bathrooms: Water temperature in both resident bathrooms were within 105-120 degrees F. LPA observed grab bars and shower chair and non skid mats. Emergency Drills: Last documented drill was conducted on 10/08/2025 at 2 pm. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Resident /Staff Files: Four (4) resident files were reviewed. LPA Vaid reviewed staff files for three (3) staff. Personnel records are maintained at facility. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Vaid observed updated infection control plan. Laundry Room: LPA Vaid observed laundry room operational and clean, toxins are locked and inaccessible to residents in care. No deficiencies cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to facility Administrator.the state’s words, verbatim · CDSS document, Dec 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met Jasbindar Singh, Administrator and explained the purpose of the visit. The facility has a capacity of six (6) to serve residents from age 60 and above which may have six (6) non-ambulatory and approved for four (4) hospice waiver. One (1) resident is on hospice. Annual fee is current. Administrator certificate is current with expiration date on 4/11/25 The visit consisted of the completion of CARE tool, interviews of staff/residents, conduct of physical plant, and reviews of food supply/ medications/ facility records. This facility is a single story house located in a residential neighborhood in Covina. The facility consisted of five (5) bedrooms which including three (3) resident bedrooms and two (2) staff bedrooms, two (2) bathrooms, office, living room, dining room, kitchen, and back yard. Kitchen was clean and had maintained the required two (2) days perishable and seven (7) days non- perishable. Each resident's bedrooms were furnished with required furniture. Adequate linen and personal hygiene supply were observed. Bathrooms inspected and were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was measured at 106.9 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Smoke detectors and carbon monoxide detectors were operable. Fire extinguishers were fully charged and last service was on 02/20/24. Fire drill was conducted on 11/19/24. Auditory devices were operable. Medication is centrally stored and current. Resident records were stored in a locked storage room and inaccessible to residents. Facility maintained a comfortable temperature of 73 degrees Fahrenheit for residents. No deficiencies cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to facility Administrator.the state’s words, verbatim · CDSS document, Nov 26, 2024

Type of visit: Office

An Informal Conference meeting was held at the Monterey Park Adult and Senior Care Regional Office. Present during this meeting were Licensing Program Manager (LPM) Fernando Fierros, Licensing Program Analyst (LPA) Bonnie Tao, Licensing Program Analyst (LPA) Tyler Reyes and from MOUNTAIN VIEW COTTAGES were Licensee Smita Sanghvit, administrator Trupti Mody, administrator Laura Hernandez, and administrator Jasbindar Singh. The following items listed below were discussed during today's meeting: · Complaint investigation findings for complaint # 28-AS-20210128160641. · Adequate staffing and appropriate care and supervision for residents in care. · Obtaining timely medical care or treatment for residents in care. · Criminal Record Clearance and Associating staff. · Maintenance and Operation: Facility shall be kept clean and in good repair. The facility free from pest. · Immediate Civil Penalties The following Title 22 topics were discussed and a copy of the Section given during office meeting: · Personnel Requirements – General Section 87411 · Maintenance and Operation Section 87303 · Storage Space Section 87309 · Care of Persons with Dementia Section 87705 · Criminal Record Clearance Section 87355 (-continued in LIC 809C-) Licensee was requested to provide procedure plan regarding staff obtaining timely medical care/ treatment for residents by due date 2/21/24. An exit interview was conducted with Licensee and Administrators, and a copy of this licensing report was provided.the state’s words, verbatim · CDSS document, Feb 14, 2024

Allegation investigated: Resident suffered a fall resulting in a fracture. Staff did not seek medical attention in a timely manner.

Licensing Program Analyst (LPA) V. Maldonado conducted an unannounced subsequent complaint visit to the facility for the purpose of investigating the above-mentioned allegations. LPA Maldonado met with Administrator, Jasbindar Singh, and explained the purpose for the visit. On 01/29/21, Licensing Program Analyst (LPA) Tao conducted the initial complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted via tele-conference with Administrator, Jasbindar Singh. During the virtual visit, LPA Tao conducted a health and safety check and requested a copy of the Staff and Resident roster. LPA Tao virtually toured the facility via Facetime with Administrator and observed that the facility is clean and in good repair. LPA observed nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. LPA Tao observed wash basins, showers/bathtubs and toilets were operable and did not observe any immediate health and safety concerns. (Report Continued on LIC9099-C...) Substantiated The investigation of the above-mentioned allegations was conducted by the licensing agency's Investigation Bureau. The investigation was conducted by the assigned Investigator, Dennis Seng and consisted of the following: Interviews conducted with Administrator (S1) and Staff #2 - #3 (S2 & S3), Residents #1 - #4 (R1, R2, R3 & R4), Witnesses #1 & #2 (W1 & W2), and Staff at other agencies (W3 & W4), including Adult Protective Services and Long-Term Care Ombudsman program. Investigator Seng also reviewed R1's facility file/documentation, including incident reports dated 10/23/20, and medical records dated 11/03/20 and 11/06/20. The investigation revealed the following: Regarding allegation: Resident suffered a fall resulting in a fracture. It was alleged that R1, who was deemed a fall risk, fell over a raised threshold in the doorway while ambulating, due to staff failing to assist R1. Interviews with (4) of (4) staff indicated that R1 fell in the facility and that R1’s family did not want the facility staff to call 911. (3) of (4) residents interviewed could not corroborate the allegations. Per incident report dated 10/23/20, it was indicated that R1 had a fall at the facility, was helped back into bed, and responsible parties were notified. Interviews with W1-W2 revealed that on 10/23/20, R1 called W1-W2 regarding the fall and stated to be in pain and asked to go to the hospital. However, facility staff informed W1-W2 that staff were unable to arrange R1’s transportation. Interviews with W3-W4 revealed that R1 fell in the facility on 10/23/20 and was not seen by a medical professional until early November 2020. Review of R1's file revealed that R1 was a fall risk as indicated on R1’s Individual Service Plan, dated 09/17/20. Therefore, based on the investigation, the facility failed to provide resident with adequate care and supervision, which resulted in R1 falling and sustaining an injury. Regarding Allegation: Staff did not seek medical attention in a timely manner. It was alleged that after R1 fell at the facility while being a fall risk, R1 expressed pain to staff and requested an x-ray be taken; However, staff did not obtain medical treatment for the resident until a week later. During the investigation, Investigator Seng reviewed R1’s facility file/documentation, including incident reports dated 10/23/20, and medical reports dated 11/03/20 and 11/06/20. Per the incident report dated 10/23/20, R1 fell over a raised threshold in doorway at the facility while walking into R1’s room. R1 informed S3-S4 that R1 was in pain and wanted to go to the hospital to get an x-ray. Administrator and staff spoke with W1-W2, and per Administrator, W1 and W2 requested R1 not be sent out for medical treatment. Per medical records review, it was discovered that R1 did not receive medical treatment until 11/03/20, which was (11) days after the fall occurred 10/23/20. X-rays taken on 11/06/20 revealed that R1 sustained a fracture to the right hand. Therefore, based on the investigation, staff failed to seek timely medical attention for R1, after R1 fell at the facility and expressed pain to staff, which resulted in a fracture to R1's right hand. (Report continued on LIC9099-C...) Based on interviews conducted and documents reviewed, the preponderance of evidence standard has been met, therefore, the above allegations are found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, and Chapter 8, deficiencies will be cited on the attached LIC9099-D. An immediate $500 civil penalty is being issued during today's visit due to the lack of care and supervision that occurred on 10/23/20 when R1 fell in the facility and sustained a fractured right hand. “The licensee was informed that a civil penalty might be assessed based on the Health & Safety Code 1569.49(e) or (f), or 1548(e) or (f), or 1568.0822(e) or (f).“ An exit interview was conducted and a copy of this report, along with appeal rights, were discussed and provided to Administrator, Jasbindar Singh. During today's visit, LPA Maldonado obtained a copy of the resident and staff rosters, Facesheet and Physician's Reports for Residents# 2, and #5-7 (R2, and R5-R7), and conducted a tour of the physical plant with assistance of Administrator Singh. Interviews were also conducted with Staff# 1 and #4 (S1 and S4), and attempted interviews with R2, and R5-R7. The investigation revealed the following: Regarding allegation: Facility is in disrepair. It was alleged that during the winter months of 2020, the facility heater was in disrepair for one month and delays in plumbing issues on a single toilet shared by (5) residents. Per interviews with staff, S1 stated that although the central heating system was not operating properly for a short period of time, individual heater units were brought in the home and each resident had one placed in their room. S1 also stated that although they did have a plumbing issue on Thanksgiving Day of 2020 in one restroom, the residents were able to use the other restroom in the home, as needed. S4 states no work receipt is available, but recalls the incident and stated that a plumber came the following day to repair it, as it was difficult to have anyone come out on Thanksgiving Day. S4 could not corroborate the allegation as S4 states to not have worked at the facility at the time of the alleged. (4) of (4) residents could not corroborate the allegation. During the tour of the physical plant, LPA observed the thermostat temperature set at 82*F inside the home. LPA observed all resident rooms and common areas to have heat vents, and observed them to be operating properly. LPA also inspected the (2) bathrooms in the home and observed them to be clean, sanitary, and were operable during the visit. Regarding allegation: Staff did not provide an adequate amount of food to resident. It was alleged that R1 did not receive enough food during meals and was given (4) yogurts for Thanksgiving dinner. (2) of (2) staff interviewed denied the allegations and stated that there is always sufficient amount of food/groceries available at the facility for residents. Staff stated that residents are provided with (3) meals and (3) snacks of their choice every day. (1) of (4) residents interviewed denied the allegation and stated that sufficient food is given during meals and snacks are always available. LPA attempted interviews with (3) of (4) residents- they could not corroborate the allegation. During the tour of the physical plant, LPA inspected the food supplies and observed a sufficient amount of perishable and non-perishable foods available for the number of residents in care, which included milk, eggs, vegetables, meats, cereals, cookies, oatmeal, pudding cups, and fresh fruits. (Report continued on LIC9099-C...) Regarding allegation: Resident was denied food. It was alleged that facility staff denied R1 more food, after not receiving enough food to satisfy R1's hunger. (2) of (2) staff interviewed denied the allegation and stated that there is always sufficient food at the facility to give to residents if they wish to have more. Staff also stated that the residents are allowed to take whatever they wish at any time from the kitchen or pantry. They may sometimes request it directly from staff and staff will assist the residents with it. Staff stated that residents are provided with (3) meals and (3) snacks of their choice, per day. (1) of (4) residents interviewed denied the allegation and stated that all residents are given whatever amount of food they want. LPA attempted interviews with (3) of (4) residents- they could not corroborate the allegation. During the tour of the physical plant, LPA inspected the food supplies and observed a sufficient amount of perishable and non-perishable foods available for the number of residents in care, which included milk, eggs, vegetables, meats, cereals, cookies, oatmeal, pudding cups, and fresh fruits. LPA did not observe any food items hidden, locked, or inaccessible to residents in care. Based on the LPA's record review, interviews, and observations, the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Administrator, Jasbindar Singh, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 28-AS-20210128160641

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Dec 13, 2023

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interviews and records review, facility staff failed to provide necessary supervision for (1) of (4) residents who fell at the facility and resulted in a fractured hand, which poses an immediate Health, Safety, or Personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Licensee will submit a plan in writing on how facility staff will ensure to meet the needs of all residents including proper care and supervision, per their Individual Needs and Services Plans. Written plan to be submitted to LPA via email by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(g) · Plan of correction due date: Dec 22, 2023

87465 Incidental Medical and Dental Care (g)The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health... This requirement was not met as evidenced by: Based on interviews and records review, facility staff failed to seek timely medical attention for (1) of (4) residents, after falling in the facility and sustaining a fracture to the right hand, which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Licensee will conduct in-service training for all facilty staff on obtaining proper medical care for residents as needed/required. Copy of training material and sign-in sheet to be sent to LPA via email by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 11/26//2023. LPA was met by Administrator Jasbindar Singh and explained the purpose of the visit. The facility is licensed to serve six (6) non ambulatory residents over the age of 60 and has an approved hospice waiver for four (4). LPA OBSERVATIONS: The facility is a single-story dwelling located on a main street with three (3) resident bedrooms, two (2) staff bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Front Yard: Was clean and well maintained. LPA Ramirez observed gate that leads to backyard to be wide open. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to four (4) out of four (4) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located nearby kitchen hallway cabinet, to be accessible to four (4) out of four (4) residents in care. LPA Ramirez observed a sign posted on cabinet door indicating to “lock cupboards at all times”, a pad lock was observed but not secured. Kitchen sink water temperature was measured at 114.2 degrees F. Kitchen appliances were observed to be clean and in working order. Two cabinet doors located by sink were in disrepair. Cabinet drawer containing paper items was loose and not opening correctly to its original design. LPA could see exposed nails. Upper cabinet door containing resident plates, cups and other dishware, was missing doorknob. Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 78 degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. SEE 809-C Resident Rooms 1 - 3: LPA Ramirez inspected three (3) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. Auditory device located on resident#2 exit door that leads to back yard, was observed to be in “Off” position. Administrator Singh placed device in “On” position after LPA Ramirez expressed concern. Bathrooms: Water temperature in both resident bathrooms were within 105- 120 degrees F. Bathroom #2 located near laundry room was observed to have 6 x 6 gap in flooring. LPA touched flooring and wood felt soft and wet. LPA Ramirez observed wall near outside shower tile to be stain with brownish-yellow stains, dry wall was peeling and cracking on both sides. Backyard: Was clean and well maintained. Plenty of shade and seating was observed. LPA Ramirez observed back yard gate to be wide open. Emergency Drills: Last documented drill was conducted on 11/11/23 at 3 pm. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for three (3) staff. Resident Files: Four (4) resident files were reviewed. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. Laundry Room: LPA Ramirez observed laundry room door to be wide open and access to bleach and laundry soap were observed. LPA Ramirez observed two (2) back doors near laundry room, to have auditory devices switched in “OFF” position and doors were observed to be wide open. Deficiencies are being cited and a copy of this report, 809-D and appeals rights was provided.the state’s words, verbatim · CDSS document, Nov 26, 2023