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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 02/25/2020
Date Signed: 02/26/2020 11:26:17 AM



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
11/19/2019 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20191119100314
FACILITY NAME:MONTERA, THEFACILITY NUMBER:
374604083
ADMINISTRATOR:BECK, KRISTINFACILITY TYPE:
740
ADDRESS:5740 LAKE MURRAY BLVDTELEPHONE:
(949) 242-1400
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:225CENSUS: 82DATE:
02/25/2020
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Associate Executive Director, Kellie ShearerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff do not respond to resident's call button in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA was met and granted entry into the facility by Associate Executive Director, Kellie Shearer to whom was informed of the purpose for the visit.
The Department’s investigation consisted of staff and resident interviews. It also consisted of facility, and resident records review.
It was alleged that staff do not respond to pendant calls in a timely manner. During the investigation LPA Correia, accompanied by Acting Executive Director Karen Moore, tested the call response time by pressing a resident’s pendant which resulted in a delayed response time. Interviews conducted with residents also revealed that there were delayed response times. Interviews with managerial staff revealed starting in January of 2020 disciplinary action was taken by the facility for delayed response times to pendant service calls, illustrating acknowledgment and efforts to address the issue. In addition, the facility did not have electronic call logs available for certain periods of time for review.
Based on LPA’s observations, records review, and interviews conducted with residents and staff, the above allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met.
Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached LIC 9099-D. An exit interview was conducted, Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to Associate Executive Director, Kellie Sheare and their signature on this form confirm receipt of these rights.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
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-20191119100314
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: MONTERA, THE
FACILITY NUMBER: 374604083
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2020
Section Cited
CCR
87411
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Personnel Requirements...
Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement was not met as evidenced by:
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Facility staff will create a plan on how Management will address the issue. The plan and a copy of April 2020 call log will be submitted to CCL by POC date.
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Based interviews with 10 out of 10 residents there is a delay in response to pendant calls. LPA also tested a pendant that resulted in a delay. Administrator also stated staff are aware of the delay. This poses a potential safety risk to the residents in care.
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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 JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2