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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045920055
Report Date: 07/16/2024
Date Signed: 07/16/2024 02:40:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20240424125527
FACILITY NAME:MONTE VISTAFACILITY NUMBER:
045920055
ADMINISTRATOR:WEBSTER, SIMONIEFACILITY TYPE:
735
ADDRESS:1262 14TH STREETTELEPHONE:
(530) 888-5000
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:12CENSUS: 6DATE:
07/16/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jessie Boothe - administratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not treat resident with dignity and respect. - UNSUBSTANTIATED
Staff did not keep the facility clean and sanitary. - UNSUBSTANTIATED
Staff did not keep the facility free from pests. - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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07/16/2024 02:00 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Jessie Boothe. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation the administrator and staff were interviewed. LPA reviewed the following documents: Admission agreement, Physicians Report, IPP for 2 clients, housekeeping schedule, pest control invoices, staff schedule for April 2024.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
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 3
Control Number 59-AS-20240424125527
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MONTE VISTA
FACILITY NUMBER: 045920055
VISIT DATE: 07/16/2024
NARRATIVE
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Staff did not treat resident with dignity and respect. – UNSUBSTANTIATED

It was reported that staff are verbally abusive and "threatening" toward a client.

Staff stated that C1 complained mainly because staff didn’t allow C1 the freedom to leave the facility without a conservator or someone with her. Recently C1 received approval from their conservator to take walks down the street but C1 had to sign out and let staff know they were leaving.

Administrator stated that C1 would get upset when they had to report her to behavioral health. C1 felt slighted and thought staff were “out to get” them. C1 started cheeking their meds and then refusing them, then their erratic behavior started.

It was determined that staff are not threatening nor abusive to C1. C1 had recently started refusing their medications and this affected their perception of their interactions with staff. This allegation is unsubstantiated.

Staff did not keep the facility clean and sanitary. – UNSUBSTANTIATED

It was reported that staff do not keep the facility clean. The RP states the toilets are not kept clean.

LPA reviewed the list of client chores that is located in the common area.

Staff stated the toilets are cleaned daily and the clients are responsible for this chore but if they don’t get it done staff does it.

Administrator stated the toilets are generally cleaned a couple of times each day. All of the clients have chores and they clean in the mornings, staff prompts the clients to do their chores. Staff checks everything and if there are extra chores the staff do them. There is one client who leaves a mess in the bathroom. All the chores are checked by staff. The clients do the chores because they are building life skills.

It was determined that the clients are responsible for completing chores with support from staff. If a chore is not completed the staff will complete the chore. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20240424125527
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MONTE VISTA
FACILITY NUMBER: 045920055
VISIT DATE: 07/16/2024
NARRATIVE
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Staff did not keep the facility free from pests. – UNSUBSTANTIATED

It was reported that that the facility has cockroaches.

LPA reviewed invoices from Hobbs Pest Solutions dated 11/01/2023, 01/02/2024, and 03/06/2024 for bi-monthly service.

Staff stated they have seen a couple of dead cockroaches in the hallway. Staff stated that the facility has pest control come in and spray.

Administrator stated occasionally cock roaches will come in from the orchard that is located behind the facility. The landlord has pest control come and spray every other month. They have never seen any live insects in the facility, there have been some dead insects found in the game room.

It was determined the facility is susceptible to insects due to their location. The landlord has pest control come and spray every other month. There has never been a live insect observed in the facility. This allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to administrator Jessie Boothe.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3