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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603462
Report Date: 10/30/2020
Date Signed: 10/30/2020 02:28:13 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2019 and conducted by Evaluator Dawn Segura
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20190930112618
FACILITY NAME:VILLA MONTICELLO ASSISTED LIVINGFACILITY NUMBER:
374603462
ADMINISTRATOR:ORLANDO DYFACILITY TYPE:
740
ADDRESS:25695 N. CENTRE CITY PARKWAYTELEPHONE:
(760) 738-1555
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:29CENSUS: 19DATE:
10/30/2020
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Dolores McGonigalTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff force feeds residents.

Staff handles residents in a rough manner.

Staff yell at residents.

Facility is unsanitary.

Staff are not following proper universal precautions.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted a virtual visit, via video conferencing, to deliver investigative findings. LPA spoke with Dolores McGonigal, Resident Services Manager, to whom she explained the reason for the virtual visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegations. The investigation consisted of a review of facility records and interviews with staff and outside sources.

In response to the first allegation, it was alleged that staff was observed force feeding residents by giving a resident too much food at once and insisting that a resident keep their hands near their chest while being fed large amounts of food in an effort to rush the resident to finish eating. During the course of the investigation, LPA discovered that residents are often assisted with eating or, if needed, fed by staff. It was also revealed that one resident in particular, at times, stores too much food in their mouth at once, which causes a potential choking hazard. Staff will sometimes assist in feeding, despite the resident’s ability to self-feed. However,
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
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 6
Control Number 08-AS-20190930112618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: VILLA MONTICELLO ASSISTED LIVING
FACILITY NUMBER: 374603462
VISIT DATE: 10/30/2020
NARRATIVE
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LPA was not able to obtain evidence to indicate that residents are being force fed. Interviews conducted did not yield any information to corroborate the allegation.

In response to the second allegation, interviews with staff and outside sources who visit the facility often did not yield information to conclude that residents in the facility have been observed to be handled in a rough manner. Evidence revealed that staff, at times, may exert extra effort to accomplish the task of moving residents who are often unable to provide much assistance in their own movement, but evidence obtained did not lead to a conclusion that staff are abusive or excessively rough in handling residents while providing care.

In response to the third allegation, as is common in senior care environments, some of the facility’s residents are hard of hearing. Interviews revealed that staff may raise their voice to be heard when speaking to residents who are hard of hearing. Additionally, Staff 2 (S2) [an LIC 811 Confidential Names List was provided to identify the staff] for whom English is not their primary language, has been identified as speaking in a tone that may seem to be abrupt or aggressive; however, information obtained through interviews indicates that the staff’s tone is a result of an experienced language barrier and the staff’s attempts at getting residents to understand, as well as a cultural difference in tonal modes of communication. LPA did not obtain sufficient evidence to conclude that S2 or other staff yell at residents in an intentionally offensive manner.

Relative to the allegation of the facility being unsanitary, it was discovered during the investigation that staff members on each of the three shifts are responsible for performing cleaning tasks, in addition to daily housekeeping duties that are performed by housekeeping staff. Additionally, interviews with outside sources and LPA’s personal observation revealed that the facility has been maintained in a clean and sanitary manner when observed during visits.

It was alleged that staff are not following proper universal precautions by not changing gloves between providing care to different residents, using one bucket of shared community items, such as butt cream, shampoo, lotion, and not leaving cleaning products in the bathrooms to use between
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20190930112618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: VILLA MONTICELLO ASSISTED LIVING
FACILITY NUMBER: 374603462
VISIT DATE: 10/30/2020
NARRATIVE
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bathroom usages. Interviews conducted during the course of the investigation reflected that caregivers change gloves and wash their hands frequently throughout the day, and staff change gloves when moving between residents. Evidence gathered indicated that residents have their own individual buckets that contain their personal hygiene items. While there may be items that can be used on more than one resident, those items are shampoo and conditioner, which is squeezed from a bottle that does not come in direct contact with residents. The investigation did not yield evidence to indicate that staff are not changing gloves, as necessary, or that hygiene products are used communally from resident to resident in a way that could negatively impact the health or safety of the residents. Relative to cleaning products not being left in the resident bathrooms, in accordance with Title 22 regulations, facilities are not permitted to leave cleaning products that could potentially be harmful to residents in areas where they would be accessible to residents with dementia. Cleaning products with disinfecting properties are available in the facility and accessible for staff use; however, those products are stored in a locked central location in an effort to protect the health, safety, and wellbeing of residents in care.

Community Care Licensing has not obtained sufficient evidence to corroborate the above-listed complaint allegations. Based upon evidence gathered during the investigation, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2019 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20190930112618

FACILITY NAME:VILLA MONTICELLO ASSISTED LIVINGFACILITY NUMBER:
374603462
ADMINISTRATOR:ORLANDO DYFACILITY TYPE:
740
ADDRESS:25695 N. CENTRE CITY PARKWAYTELEPHONE:
(760) 738-1555
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:29CENSUS: 19DATE:
10/30/2020
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Dolores McGonigalTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Facility does not have proper staff TB screening on file.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted a virtual visit, via video conferencing, to deliver investigative findings. LPA spoke with Dolores McGonigal, Resident Services Manager, to whom she explained the reason for the virtual visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. The investigation consisted of a review of facility records and interviews with staff and outside sources.

It is alleged that the facility does not maintain TB test results for staff. It was reported that two staff began working at the facility without providing proof that a TB test had been administered and produced negative results. A review of facility records and interviews revealed that S6 was employed by licensee to work at the facility from 5/22/2019 until 9/30/2019. Records maintained by the facility reflect that a health examination and TB test were not administered to S6 until 10/21/2019. While the results of both reflected that S6 was physically qualified to work in the facility, the time at which the screening and test were completed were

Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 08-AS-20190930112618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: VILLA MONTICELLO ASSISTED LIVING
FACILITY NUMBER: 374603462
VISIT DATE: 10/30/2020
NARRATIVE
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beyond the time frame allotted for completion by a newly hired employee.

Based upon the evidence obtained, the allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. The deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D. An exit interview was conducted, via virtual visit, and a copy of this report and Licensee/Appeal Rights (LIC 9058 01/16) were provided to Dolores McGonigal, Resident Services Manager, via electronic mail. An electronic read receipt confirmation was requested to be sent by the Resident Services Manager upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20190930112618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VILLA MONTICELLO ASSISTED LIVING
FACILITY NUMBER: 374603462
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2020
Section Cited
CCR
87411(f)
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87411(f) Personnel Requirements–General.
All personnel. . .shall be in good health. . . Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven
(7) days after employment or licensure. This
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Resident Services Manager provided a health screening and proof of an intradermal test, dated 10/21/2019 and results read on 10/30/2019, completed for S6 to Community Care Licensing.

Deficiency cleared at the time of visit.
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req't was not met as evidenced by: Based on record review, the facility did not obtain and maintain a health screening performed not more than 6 months prior to or 7 days after employment for 1 (S6) of 6 staff whose files were reviewed. This posed a potential health risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
LIC9099 (FAS) - (06/04)
Page: 6 of 6