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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603589
Report Date: 09/26/2023
Date Signed: 09/26/2023 01:12:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/18/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20210518142402
FACILITY NAME:MONTE VISTA VILLAGEFACILITY NUMBER:
374603589
ADMINISTRATOR:SUSAN BERWINFACILITY TYPE:
740
ADDRESS:2211 MASSACHUSETTS AVENUETELEPHONE:
(619) 465-1331
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:0CENSUS: 114DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Adrian Guillen, AdministratorTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff are not meeting resident's needs
Facility is not providing activties for residents
Facility has trash everywhere
Staff are not providing comfortable furniture for resident's
Facility is not abiding by admission agreements
Resident's are being denied food service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Adrian Guillen, Administrator to discuss the purpose of the visit.

LPA conducted interviews, made observations, and obtained and reviewed pertinent records. It was alleged that staff are not meeting resident's needs. Interviews revealed that the staff are bringing the residents their food due to covid protocols. The residents let the staff know what they want after being notified of whats being served and they have a few choices. Interviews revealed that if a resident calls to the staff the staff will assist them with whatever they need. The staff are all practicing social distancing while assisting the residents unless if they have to be up close. There were no witnesses that reported staff are not meeting resident's needs.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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 08-AS-20210518142402
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MONTE VISTA VILLAGE
FACILITY NUMBER: 374603589
VISIT DATE: 09/26/2023
NARRATIVE
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It was alleged facility is not providing activities for residents. Interviews revealed that
they are dropping off activities for the residents to do at this time since we are in a pandemic. Interviews revealed most of the residents deny the activities but for those that want it they are offered. Interviews revealed they have activities such as coloring, crosswords, puzzles and cards. There were no witnesses that reported facility is not providing activities for residents
It was alleged that facility has trash everywhere. Interviews revealed the staff pick up trash when they see it and also reported they have maintenance workers that work all day that keep the grounds clean and preserved. Interviews revealed if there is piece of trash like a napkin or anything like that they will just pick it up and toss it if the maintenance person has not got to it at that time. There were no witnesses that reported facility has trash everywhere.
It was alleged that staff are not providing comfortable furniture for resident's. Interviews revealed the staff do not provide the residents any furniture. The owners of the facility provide tables and chairs to sit on in the cafeteria and outside patio furniture. Interviews revealed there are people that sit in the chairs and will sit there for hours. There were no witnesses that reported staff are not providing comfortable furniture for resident's.
It was alleged that facility is not abiding by admission agreements. Interviews revealed that the staff follow along with the resident's admission agreements because that is how they determine how much care the residents needs and how much they will pay for those services. Interviews did not reveal any witnesses that reported the facility is not abiding by admission agreements
It was alleged that resident's are being denied food service. Interviews did not reveal that any of the residents were being denied food. Interviews revealed that the residents had a variety of meals to choose from daily and snacks for them throughout the day. The residents are able to choose what they would like to eat. There were no witnesses that reported resident's are being denied food service
Based on the evidence obtained from interviews, records review, and observation the complaint allegations are unsubstantiated. An exit interview was conducted with Adrian Guillen, Administrator 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 JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2