374603589-1-20-2023-08-AS-JRAE-CNM2ED-20230131161946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603589
Report Date: 01/20/2023
Date Signed: 01/20/2023 02:37:31 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, 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
12/28/2020 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20201228100611

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: 120	DATE:	01/20/2023
		UNANNOUNCED	TIME BEGAN:	11:48 AM
MET WITH:	Barbara Delgado, Business office Manager		TIME COMPLETED:	12:19 PM

ALLEGATION(S):

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Facility in disrepair
Food service

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Tiffany Holmes conducted an unannounced complaint visit to deliver findings on the above-mentioned allegations. LPA met with Barbara Delgado, Business office Manager, and we discussed the allegations. Investigation consisted of staff, residents, and outside witness interviews and records review.

It was alleged the facility is in disrepair. Imterviews revealed that anytime there is anything that needs to be worked on the residents can call to the front desk and explain to them what is needed. The front desk staff will then proceed to do a maintenance service request and then the maintenance will go and fix the issue. On or around December 4, 2020 a service list came through for Resident 1 (R1) and the work began on their apartment. The items were corrected and even some items that were R1s responsibility the facility helped with because of covid. Interviews revealed there was one window that was hard to open and WD40 would loosen the window but R1 refused the WD40. The unit was freshly painted and the window was hard to open due to the fresh paint. After some time of wiggling it back and forth they opened the window. Interviews revealed once the service requests have been completed the staff let the Director know about the completed work.

Unsubstantiated

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: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20201228100611

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: 01/20/2023

NARRATIVE

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It was alleged that food service did not provide cooked meals. Interviews revealed that the food is cooked thoroughly daily and prepared with the freshest ingredients. There are a variety of foods and snacks that the residents can choose from. If there is ever an issue with the food the staff will quickly assist to correct the issue. Interviews with residents did not show any issues with the food service or the food items that was being served. Another interview revealed that there has been a time when their food was undercooked and not what they ordered. There were no other interviews that stated their food was undercooked.

Interviews with residents did not corroborate the allegations facility in disrepair and food service did not provide cooked meals. Based on the evidence obtained from interviews, records review, and observation the complaint allegations are unsubstantiated.

An exit interview was conducted with Barbara Delgado, Business office Manager and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany Holmes	TELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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