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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202747
Report Date: 03/20/2022
Date Signed: 04/03/2022 10:27:51 PM

Unsubstantiated


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
11/23/2021 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 26-AS-20211123151121
FACILITY NAME:DEL MONTE ASSISTED LIVING FACILITY, THEFACILITY NUMBER:
275202747
ADMINISTRATOR:SANDEEP SAINIFACILITY TYPE:
740
ADDRESS:1229 DAVID AVETELEPHONE:
(831) 375-2206
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:49CENSUS: 44DATE:
03/20/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility staff Gloria GarrisonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff do not supervise residents
Licensee did not designate coverage for administrator's absence
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on March 20, 2022 at 09:00 a.m. to investigate a complaint on the above allegations. LPA met with facility staff Gloria Garrison and explained the purpose for today’s visit.

Regarding the allegation licensee did not designate coverage for administrator's absence. Based on LPA interviews, records reviewed, and LPA observation the Licensee does have designated coverage for administrator’s absence. LPA reviewed the LIC 308 designation of facility responsibility and the document has 5 listed authorized persons to be present at the facility during the Administrators absence. LPA observed three of the authorized persons listed at the facility during the visit along with the Licensee. The facility Administrator was also present during the visit. Staff 2 stated during interviews he is designated to cover in the case of Administrators absence, and he was present at the facility on November 23. 2021. Therefore, this complaint is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.




Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
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)
Page: 1 of 2
Control Number 26-AS-20211123151121
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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Regarding the allegation staff do not supervise residents. Based on LPA interviews conducted with residents, LPA observation, and LPA review of facility records. LPA interviews conducted reflect the majority of residents feel they are being properly cared for by staff. LPA observed staff serving residents food and caring for residents. LPA reviewed staff schedule documenting on any given day there is 5 morning caregivers, and one medication technician, 3 evening caregivers along with one medication technician, and three overnight caregivers. Therefore, this complaint is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with facility staff Gloria Garrison and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
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)
Page: 2 of 2