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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 02/15/2023
Date Signed: 02/15/2023 04:51:00 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
01/30/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230130141621
FACILITY NAME:MONTERA, THEFACILITY NUMBER:
374604083
ADMINISTRATOR:EMILY TURNERFACILITY TYPE:
740
ADDRESS:5740 LAKE MURRAY BLVDTELEPHONE:
(619) 832-2599
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:225CENSUS: 187DATE:
02/15/2023
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Director of Health Services, Perla ProvencalTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Facility staff did not contact resident's physician after change in condition
Facility staff did not meet resident's hygiene needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Director of Health Services, Perla Provencal and Director, Connections for Living, Aileen Spence. Executive Director, Emily Turner, joined the meeting via telephone.

The Department investigated the above listed complaint allegations. The investigation consisted of a tour of the facility, multiple interviews with staff and outside sources, and records review, including relevant evidence pertinent to this investigation.

On January 30, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff did contact resident’s (R1) physician after change in condition, [an LIC 811 Confidential Names List was provided to staff to identify the Resident (R1)]. It was specifically alleged that on January 21, 2023, a skin rash was observed on R1’s extremity and that staff did not contact R1’s physician to obtain medical attention. (Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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 5
Control Number 08-AS-20230130141621
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
VISIT DATE: 02/15/2023
NARRATIVE
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(Continue from LIC9099)

However, a review of R1’s medical records, charting case notes, and medication administration records (MARs) indicated that staff contacted R1’s Primary Care Physician (PCP) regarding the skin rash on January 16, 2023. Further review of records indicated that R1’s PCP ordered a prescription on January 17, 2023, for cream to treat the skin rash. Review of R1’s MARs confirmed facility staff followed doctor’s orders and applied medication topically 2x per day to affected area for 10 days. On February 3, 2023, during a visit, facility staff confirmed that R1 had completed the course of treatment and the skin rash was no longer active. During interviews, staff consistently stated that they were required to contact PCPs and responsible parties when there was a change in condition. Based on records review and interviews with staff and outside sources there was insufficient evidence to support this allegation.

It was also alleged that staff did not meet R1’s hygiene needs. It was specifically alleged that on Monday, January 30, 2023, R1 was observed with greasy hair and noticeable body odor. In addition, it was also alleged that R1 had dirt and dried blood underneath their fingernails. Review of medical records indicated that R1 had a diagnosis of contact dermatitis (itchy rash) which was causing R1 to scratch their skin.
The rash was under medical treatment as noted during the time in question.

Review of R1’s personal care sheets and facility shower schedule indicated that R1 received showers as scheduled for the week ending February 4, 2023. R1 received showers on Sunday, January 29, 2023, and on Tuesday, January 31, 2023, in accordance with basic services. During interviews, staff indicated that as normal protocol caregivers were required to complete full body checks during residents’ showers and document their findings on the residents’ personal care sheets. No exceptions were noted during the review of R1’s personal care sheets for the months of December 2022 and January 2023.

During a visit on February 3, 2023, R1 was observed to be clean, dressed and groomed appropriately, with no noticeable body odor. During the visit, R1 was observed getting their nails polished during the “Spa Day” activity. R1’s hands and nails were observed to be clean. Staff indicated that “Spa Day” was a complimentary activity offered once a week, which consisted of washing, cleaning, filing and polishing nails. Nail trimming was not included as part of this activity and staff were not allowed to cut/trim nails.

(continue on LIC9099C)
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20230130141621
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
VISIT DATE: 02/15/2023
NARRATIVE
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(Continue from LIC9099C)


Review of the facility’s admissions agreement indicated that the facility offered full-service manicures and/or visits with the podiatrist as an “optional service” at an extra cost. Review of R1’s signed admissions agreement indicated these optional services were not included as covered services. Interviews with outside sources indicated that during their regular virtual meetings with R1, they consistently observed R1 to be clean, dressed and groomed appropriately. In addition, outside sources did not express any concerns over R1’s hygiene care.

Due to a lack of evidence, both allegations are deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violations occurred.

An exit interview was conducted with Director of Health Services, Perla Provencal and Director, Connections for Living, Aileen Spencer to whom a copy of this report, LIC 811 and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/30/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230130141621

FACILITY NAME:MONTERA, THEFACILITY NUMBER:
374604083
ADMINISTRATOR:EMILY TURNERFACILITY TYPE:
740
ADDRESS:5740 LAKE MURRAY BLVDTELEPHONE:
(619) 832-2599
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:225CENSUS: DATE:
02/15/2023
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Director of Health Services, Perla ProvencalTIME COMPLETED:
04:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not follow resident's care plan
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Director of Health Services, Perla Provencal and Director, Connections for Living, Aileen Spence. Executive Director, Emily Turner, joined the meeting via telephone.

The Department investigated the above listed complaint allegation. The investigation consisted of a tour of the facility, multiple interviews with staff and outside sources, and records review, including relevant evidence pertinent to this investigation.

On January 30, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff did not follow Resident R1’s care plan, [an LIC 811 Confidential Names List was provided to staff to identify the Resident (R1)]. It was specifically alleged that facility staff requested, (date could not be determined), a prescription for an injection of Zyprexa from R1’s Primary Care Physician (PCP).
(Continue on LIC9099C)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20230130141621
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
VISIT DATE: 02/15/2023
NARRATIVE
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CContinue from LIC9099A)


Review of R1’s care plan, medication administration records (MARs) and other medical records indicated that this medication was ordered by the PCP on 9/16/2022, however, facility staff contacted the pharmacy and the PCP to let them know that R1 was already prescribed the medication in tablet format. Review of the MARs indicated that R1 had an active prescription from their psychiatrist for “Olanzapine” in tablet format which is the same medication as Zyprexa. During interviews, staff consistently denied requesting or ordering this medication. Interviews with outside sources indicated that they were not aware R1 had this medication ordered and had no concerns related to medication management or the resident’s care plan.

Based on the results of the investigation, which consisted of observations, interviews with key staff and outside sources, and review of pertinent resident and facility records there was no evidence found to support this allegation. The Department has found that the complaint allegation was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Director of Health Services, Perla Provencal and Director, Connections for Living, Aileen Spencer to whom a copy of this report, LIC 811 and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5