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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604083
Report Date: 02/05/2025
Date Signed: 02/06/2025 09:59:44 AM

Document Has Been Signed on 02/06/2025 09:59 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MONTERA, THEFACILITY NUMBER:
374604083
ADMINISTRATOR/
DIRECTOR:
EMILY TURNERFACILITY TYPE:
740
ADDRESS:5740 LAKE MURRAY BLVDTELEPHONE:
(619) 832-2599
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 225CENSUS: 189DATE:
02/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Sanjay Kabadi Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:02 PM
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Sanjay Kabadi Executive Director and Robin Mendez Director of Health Services.
 
LPA Domingo toured the facility, performed a welfare check on residents in care, interviewed staff, and obtained copies of pertinent facility records. Today’s visit was in response to an incident which licensee self reported via an LIC624 Incident Report on February 4, 2025. The report described Resident #1 (R1) was found outside the community by a bystander who helped the resident back into the facility. R1 sits at the end of the facility property on their motorized wheelchair. R1 was picking up a dropped item and fell over and hit his head. The bystander saw R1 fall and brought R1 back into the facility.

R1's LIC602 Physicians Report state that R1 is able to make decisions, no cognitive deficits, and they are their own responsible party. R1 has no restrictions with leaving the facility independently, but prefers to sit at the end of the property. R1 was not off the property when the bystander assisted them back onto their wheelchair and brought the resident back into the facility.

The facility sent R1 to the hospital for evaluation, the appropriate people were made aware of the fall and the facility followed the fall protocol. Test were completed and R1 returned to the facility on the same day. R1 had an abrasion on their head. R1 did not have any sutures or open areas on their head.
 
No immediate health or safety risks were observed and no deficiencies were cited during this visit.
 
An exit interview was conducted, and a copy of this report and Licensee Appeal Rights LIC 9058 (03/22) were left with the Executive Director, whose signature on this form confirms receipt of these documents.
Simon Jacob
Amy Domingo
DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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