374603589-10-29-2020-08-AS-SJAB-BUWGFG-20201031051816

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603589
Report Date: 10/29/2020
Date Signed: 10/29/2020 05:24:31 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
02/20/2020 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20200220124627

FACILITY NAME:	MONTE VISTA VILLAGE		FACILITY NUMBER:	374603589
ADMINISTRATOR:	SUSAN BERWIN		FACILITY TYPE:	740
ADDRESS:	2211 MASSACHUSETTS AVENUE		TELEPHONE:	(619) 465-1331
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	219	CENSUS: 102	DATE:	10/29/2020
		UNANNOUNCED	TIME BEGAN:	04:33 PM
MET WITH:	Maricor Laus, Resident Services Director		TIME COMPLETED:	04:54 PM

ALLEGATION(S):

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Staff financially abused residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Tiffany Holmes contacted the facility via tele virtual visit to close out a complaint investigation due to COVID-19. LPA identified herself and discussed the purpose of the call with Maricor Laus, Resident Services Director

Investigation consisted of staff, residents, and outside witness interviews and a records review. It was alleged staff financially abused residents. Resident 1(R1) (see 811 LIC Confidential Names List) lived in the independent portion of the facility. R1 was in the assisted living area from 07/9/2019 - 09/18/2019. R1 was in assisted living area due to an ankle injury. While R1 was living in the assisted living they noticed some money ($500) was missing out of their wallet on 09/05/19.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

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 08-AS-20200220124627

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: MONTE VISTA VILLAGE	FACILITY NUMBER: 374603589
	VISIT DATE: 10/29/2020

NARRATIVE

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From there, R1 noticed money missing out of their account as well and notified staff. Interviews revealed there were charges on 7/26/19 for a Fashion Nova online purchase for $615.02 and a second charge on 01/09/2020 for Wigs by Woods in the amount of $810.00 and a charge from Macys in the amount of $28.19. The bank provided R1 with the address where the Macys package was sent and R1 did not know the address.

The sheriffs were called on 01/28/2020. The sheriff came to speak to R1 on 01/29/2020 and R1 told the Sheriff they did not give S1 permission to take any money or to use their debit/credit card. The facility conducted their investigation and had evidence that pointed to Staff 1 (S1) working with R1 during that time.

The time in which R1 was in the assisted living section was the time S1 had access to R1s room and all their belongings. S1 was also in question regarding another resident and money matters. On or around 11/19/2019 S1 took a $5000 check from R2. R2 provided S1 with this check after S1 explained to R2 that a family member passed away and stated they needed money because they were broke. The memo of the check states casket/funeral. R2 wrote the check off their account and the bookkeeper of R2s account noticed the money out of the account and the canceled check around 12/17/2019. S1 was terminated as soon as the facility found out about staff taking the money. There is a policy in the staff handbook on page 14, item 28 that states the acceptance of money and other valuable gifts from residents and their family and friends by employees individually is strictly prohibited. All staff sign at this at the time of hire which states staff are not allowed to receive any monetary or personal gifts from residents.

Based upon valid disclosures, the preponderance of the evidence standard has been met, therefore, the above-mentioned allegation is substantiated. The violation is cited in accordance with California Code of Regulations, Title 22, and is recorded on the attached 9099-D (Deficiency) Page.

An exit interview was conducted with Maricor Laus, Resident Services Director via facetime/ tele virtual and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator Burwin via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200220124627

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: MONTE VISTA VILLAGE	FACILITY NUMBER: 374603589
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/29/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/30/2020 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be accorded dignity in their personal relationships with staff, residents, and other persons.	1 2 3 4 5 6 7	Licensee terminated S1 immediately. Licensee also conducted inservices with staff on Abuse, exploitation and misappropriation of property on 12/20/2019.
	8 9 10 11 12 13 14	Based on interviews conducted, Staff 1 stole money from R1 and took a large amount of money from resident 2 as a gift. This poses a potential safety risk to residents in care	8 9 10 11 12 13 14	The facility has also been ongoing inservices on Theft and loss.Planof correction of Inservice documents to CCL by 10/30/2020
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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: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

LIC9099 (FAS) - (06/04)

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