374604083-1-21-2025-08-AS-APAO-DHQMFV-20250617093454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 01/21/2025
Date Signed: 01/21/2025 05:38:06 PM

Substantiated

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
01/03/2025 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20250103115452

FACILITY NAME:	MONTERA, THE		FACILITY NUMBER:	374604083
ADMINISTRATOR:	EMILY TURNER		FACILITY TYPE:	740
ADDRESS:	5740 LAKE MURRAY BLVD		TELEPHONE:	(619) 832-2599
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	225	CENSUS: 184	DATE:	01/21/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Sanjay Kabadi Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA Domingo introduced herself and disclosed the purpose of the visit to Executive Director Sanjay Kabadi.

On December 30, 2024, it was alleged that the facility unlawfully evicted resident 1 (R1) due to R1's refusal of care, the facility can no longer meet R1's needs. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, and interviews with facility staff, and outside sources.

On January 15, 2025 an interview with the Associate Executive Director (AED) confirmed that on December 30, 2024, R1 was hand delivered a 30-day eviction letter and a certified letter was sent to R1's responsible party on this same date. The AED stated the facility could no longer meet R1's needs because of their refusal to allow certain caregivers to assist them with their activities of daily living.

(Continued on LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

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 4

Control Number 08-AS-20250103115452

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: MONTERA, THE	FACILITY NUMBER: 374604083
	VISIT DATE: 01/21/2025

NARRATIVE

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(Continued from LIC9099)

Interview with the Executive Director (ED) confirmed that on December 30, 2024, the 30-day eviction letter was given to R1 and mailed to their responsible party. The eviction letter provided to R1, did not contain specific facts; such as date, place, and circumstances concerning the reason for eviction. The ED stated that on December 20, 2024, the Director of Health Services conducted a reappraisal of R1’s condition and determined that R1 had a change of condition and new care needs. The ED stated that R1 was only allowing a few specific caregivers to assist with R1’s activities of daily living as required by the service plan. On December 20, 2024, R1 requested to have two (2) caregivers to no longer provide care for them. As a result, the ED stated there are insufficient number of remaining caregivers at the facility to meet R1’s needs.

During an interview with R1, they reported an incident with staff 1 (S1) and staff 2 (S2); that involved inappropriate behavior. R1 reported this incident to The Montera management to no avail. The Department investigated that incident and on January 14, 2024, the Department substantiated the allegations and the facility was cited. R1 reported this is the reason he does not want assistance from S1 and S2.

Records review consisting of R1’s reappraisal revealed that R1’s resident assessment conducted on November 19, 2024, stated R1 needs two (2) persons to assist with bathing, dressing and transfers. The responsible party signature was present acknowledging agreement of the assessment. According, to further records review of R1’s resident assessment conducted on November 22, 2024 stated that R1 needs a two (2) person assist with dressing and transfers. The responsible party did not sign the resident assessment dated on November 22, 2024.

The Department requested the resident assessment conducted December 20, 2024, which led to the eviction, however, the facility had no record of the assessment. In addition, the facility has no records of a care conference addressing R1's change of condition for this assessment. There were no records verifying the Medical Physician was notified of R1's of change of condition.

(Continue on LIC9099C)

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20250103115452

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: MONTERA, THE	FACILITY NUMBER: 374604083
	VISIT DATE: 01/21/2025

NARRATIVE

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(Continued from LIC9099C)

Interview with Outside source (OS1) confirmed that the facility did not conduct a care plan conference addressing R1's change in condition or resident assessment on December 20, 2024, which led to the eviction.

The Department investigated the above allegation, and the preponderance of the evidence standard was met. Therefore, the above allegation is substantiated. A deficiency was cited in accordance with the California Code of Regulations, Title 22 and is documented on the attached 9099-D. An exit interview was conducted with Executive Director Sanjay Kabadi and a plan of correction was jointly developed. A copy of these reports along with Licensee/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20250103115452

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: MONTERA, THE	FACILITY NUMBER: 374604083
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/21/2025 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident.	1 2 3 4 5 6 7	Management staff that are allowed the authority to provide eviction notices agreed to participate in outside training by 2/21/25.
	8 9 10 11 12 13 14	This requirement is not met, evidenced by: Based on interviews and records review, the Licensee did not issue a lawful eviction notice to 1 of 183 residents (R1), which posed a potential Personal Rights Risk to residents in care. Management staff that are allowed the authority to provide eviction notices agreed to participate in outside training.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

LIC9099 (FAS) - (06/04)

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