374604083-3-24-2025-08-AS-SJAB-DF7PS2-20250328113336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 03/18/2025
Date Signed: 03/24/2025 11:05:37 AM

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
12/31/2024 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20241231153119

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: 185	DATE:	03/18/2025
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Aileen Spence Associate Executive Director		TIME COMPLETED:	03:58 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not follow infection control plan to communicate with appropriate parties.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with (Title, Name), to whom LPA disclosed the reason for the visit.

On December 31, 2024, it was alleged the Facility did not follow infection control plan to communicate with appropriate parties. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, outside sources, and records review.

The Montera provided their infection control policy dated December 1, 2023. Gastrointestinal Illness/Norovirus. According to the Centers for Disease Control and Prevention (CDC), an outbreak is defined as an occurrence of two (2) or more similar illnesses resulting from a common exposure that is suspected.

(Continue on LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

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-20241231153119

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: 03/18/2025

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
26
27
28
29
30
31
32

Continued page 2 of 3

The facility infection control procedure state upon suspected GI illness outbreak, the following notifications steps are taken. Notify the Executive Director, the Executive Chef, the appropriate Senior Living corporate contact, community care licensing and contact the appropriate county health department for guidance.
Staff 1 (S1) stated Public Health was notified by email of the possible GI illness outbreak on December 10, 2024. Interview with Outside Sources 1 (OS1) revealed that their department was not notified on December 10, 2024. OS1 and S1 concluded that there was a miscommunication. Community Care Licensing was notified of the GI illness, but the Department of Public Health was not notified. The correct date the Department of Public Health was notified was December 19, 2024. Outside Source 2 (OS2) was interviewed and confirmed the GI illness outbreak started on December 10, 2024, and guidance was given, and a case log was started for residents and staff on December 19, 2024.

Montera Infection Control Plan states there is to be a Post “Infection Outbreak” signs on the outside community to notify visitors of the outbreak. During an interview Staff 1 (S1) confirmed there were no sign posted “Infectious Outbreak” outside the community to notify visitors of the outbreak as per the facility infection control plan. Staff 2 (S2) was interviewed and confirmed there were no sign posted “Infectious Outbreak” outside the community to notify visitors of the outbreak as per the facility infection control plan. Staff 3 (S3) was interviewed and confirmed there were no sign posted “Infectious Outbreak” outside the community to notify visitors of the outbreak as per the facility infection control plan. Staff 4 (S4) provided documentation that a text was sent to family members on December 18, 2024, in the afternoon. Outside source 3 (OS3) and Outside source 4 (OS4) stated the text regarding the GI illness was received on December 18, 2024, in the afternoon.

Records reviewed showed Resident 1 (R1) was having signs and symptoms of GI illness on December 10, 2024, the MD was made aware by fax and the responsible party was made aware on December 11, 2024. Resident 2 (R2) was having signs and symptoms of GI illness on December 11, 2024, the MD was made aware by fax and the responsible party was not made aware. The resident was not on the illness tracing form that was given to Public Health.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20241231153119

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: 03/18/2025

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
26
27
28
29
30
31
32

(Continued page 3 of 3)

Resident 3 (R3) was having signs and symptoms of GI illness on December 11, 2024, the MD was made aware by fax and the responsible party was made aware on the same day. The resident was not on the illness tracing form that was given to Public Health. Resident 4 (R4) was having signs and symptoms of GI illness on December 14, 2024, the MD was made aware by fax and the responsible party was made aware on the same day. The resident was not on the illness tracing form that was given to Public Health. Resident 5 (R5) was having signs and symptoms of GI illness on December 14, 2024, the MD was made aware by fax and the responsible party was made aware on the same day. The resident was not on the illness tracing form that was given to Public Health.

The Department investigated the above allegations, and the preponderance of the evidence standard was met. Therefore, the above allegation is substantiated. 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 (NAME) 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: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20241231153119

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: 03/18/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/18/2025 Section Cited CCR 87211(a)(2)	1 2 3 4 5 6 7	87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate.	1 2 3 4 5 6 7	The Licensee agrees to schedule Reporting Requirements training with management staff within 30 days. The scheduled date of training and name of vendor will be submitted to CCLD by POC due date, 4/18/25.
	8 9 10 11 12 13 14	This requirement was not met, as evidenced by: Based on records review and interviews, licensee did not follow the facility infection control plan for 4 out of 120 residents. This posed potential health and personal rights risks to persons in care.	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: 03/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4