275202747-9-13-2022-26-AS-SDOB-CJBRM6-20220916130813

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202747
Report Date: 08/16/2022
Date Signed: 09/13/2022 03:26:56 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2021 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20211110163949

FACILITY NAME:	DEL MONTE ASSISTED LIVING FACILITY, THE		FACILITY NUMBER:	275202747
ADMINISTRATOR:	SANDEEP SAINI		FACILITY TYPE:	740
ADDRESS:	1229 DAVID AVE		TELEPHONE:	(831) 375-2206
CITY:	PACIFIC GROVE	STATE: CA	ZIP CODE:	93950
CAPACITY:	49	CENSUS: 48	DATE:	08/16/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Saini and Anu Sandeep		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Residents are left in soiled clothing for extended periods of time.

Residents did not receive medications.

Residents’ medications and records are being mismanaged.

INVESTIGATION FINDINGS:

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Announced follow up complaint discussion conducted via Microsoft Teams on 08/16/2022 by Licensing Program Manager (LPM) Stephenie Doub and Licensing Program Analyst (LPA) Charlie Yang. Also in attendance were Licensee/Administrators Saini Sandeep and Anu Sandeep.
Current census was 48 residents.
The purpose of this complaint discussion was to revise this LIC 9099 to reflect some changes that were made to the allegations listed above in this complaint investigation.
Even though the investigation was completed and the allegations were deemed to be SUBSTANTIATED, there won't be any deficiencies cited since they were already recorded on a previous complaint with the same allegations.

Exit Interview
A copy of this document will be scanned and sent to the email of the Licensee/Administrators Saini and Anu Sandeep where they will sign the document and return a copy back to this LPA for the facility file.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Charlie Yang	TELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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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