275202747-3-20-2022-26-AS-SDOB-CD8NZY-20220406105508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202747
Report Date: 03/20/2022
Date Signed: 03/20/2022 10:20:33 AM

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
10/08/2021 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 26-AS-20211008121838

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: 44	DATE:	03/20/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Facility Staff Loria Garrison		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility is dirty
Faclity staff not hydrating residents
Facility staff not taking care of resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility to deliver findings for a complaint. LPA was met by Facility Staff Loria Garrison and explained the reason for the visit.

Based on interviews with staff and residents, and LPA observation the facility is hydrating residents in care. LPA interviewed residents, and all stated the staff interviewed state they help residents fill their water containers or they fill themselves. LPA observes all residents to have cups or larger containers of water in their rooms. LPA observes all facility resident bungalow common areas to have large 5-gallon water dispensers.

It was learned thorough interviews with staff, residents, review of records and LPA observation of the facility is not dirty at the time of LPA Lund visit. LPA interviewed and observed 6 facility residents’ rooms who all stated the facility caregivers and housekeepers clean their rooms at least weekly. LPA observed the facility rooms and bungalow common areas to be clean. LPA also observed housekeeping staff deep cleaning resident rooms. LPA reviewed facility staff schedule and there is housekeeping scheduled every day.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2022

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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Control Number 26-AS-20211008121838

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: DEL MONTE ASSISTED LIVING FACILITY, THE	FACILITY NUMBER: 275202747
	VISIT DATE: 03/20/2022

NARRATIVE

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Based on interviews with staff and residents, and LPA observation the residents in care are getting their resident's hygiene needs meet at the time of LPA Lund visit. Residents stated that they get showers twice a week from facility staff. Staff interviewed state they check residents who were depends every two hours intervals.

The Department (CCLD) has found the allegations. Unsubstantiated.
A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred

LPA reviewed the report with Facility Staff Loria Garrison and a copy provided.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2022

LIC9099 (FAS) - (06/04)

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