<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604083
Report Date: 04/08/2022
Date Signed: 04/11/2022 10:42:53 AM


Document Has Been Signed on 04/11/2022 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:MONTERA, THEFACILITY NUMBER:
374604083
ADMINISTRATOR:MORGAN CADMUSFACILITY TYPE:
740
ADDRESS:5740 LAKE MURRAY BLVDTELEPHONE:
(619) 832-2599
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:225CENSUS: 182DATE:
04/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Regional Director of Operations Morgan Cadmus and Executive Director Emily TurnerTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by and identified himself to receptionist Keyla Frias. LPA then met and discussed the purpose of the visit with Regional Director of Operations Morgan Cadmus and Executive Director Emily Turner.

Today’s visit was in response to an LIC624 Incident Report and a SOC341 Report of Suspected Dependent Adult/Elder Abuse that Licensee submitted to CCLD regarding Resident #1 (R1). (See LIC811 Confidential Names List for description of person identifiers). R1 told licensee that during the early morning of March 30, 2022, they were received bathroom assistance from Staff #1 (S1), a contracted caregiver. R1 alleged that S1 grabbed their arms roughly during the process. According to licensee's reports, a facility nurse and another staff performed a visual inspection of R1's hands and arms later that same morning; they found no bruising or sign of injury. Licensee also interviewed S1 as part of their internal investigation; S1's account of the incident differed from R1's.

During today's visit, LPA briefly toured the facility, interviewed R1 and staff, and collected pertinent records. LPA performed a welfare check on residents in care, to include examining R1's hands and arms, which were uninjured. It was clear from interviews, records, and LPA observation that R1 requires bathroom assistance for the maintenance of their health. No health or safety concerns were identified at this time. No deficiencies were cited.


An exit interview was conducted with Cadmus and Turner, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1