374604083-12-27-2023-08-AS-LTEZ-D2WW4E-20240229155725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 12/27/2023
Date Signed: 12/27/2023 12:02:46 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
01/07/2021 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20210107085302

FACILITY NAME:	MONTERA, THE		FACILITY NUMBER:	374604083
ADMINISTRATOR:	JUDITH PIERFAX		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:	12/27/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Executive Director Emily Turner		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Licensee did not meet a resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Emily Turner.

It was alleged that during an approximate one-month period during late 2020, Licensee’ staff did not assist Resident #1 (R1) with wearing their new prescription leg wrap devices continuously day and night (to mitigate fluid retention and weeping), which is what R1’s doctor allegedly instructed. CCLD’s investigation involved an unannounced facility tour and welfare check, review of pertinent facility and home health care records, and interviews of relevant staff and outside sources.

[CONTINUED ON LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210107085302

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: 12/27/2023

NARRATIVE

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[CONTINUED FROM LIC 9099]

According to R1’s LIC602 Physician’s Report and corroborated by their Needs and Services Plan: R1 required staff assistance with bathing and dressing, among other Activities of Daily Living (ADLs).

Dated-stamped and time-stamped facility progress notes, corroborated by an outside source interview, showed: On the day R1 was issued their new leg wrap devices (i.e., Day 1), facility staff contacted R1’s physician’s office for clarification about how they were to be worn. Not having received clarification, facility staff contacted R1’s physician’s office again on Day 3 and Day 15, respectively, without answer. R1’s responsible person was also notified about the problem. On Day 20, facility staff received clarification from the physician: R1 was to wear the leg wrap devices between 16 to 20 hours per day (which is not 24/7 as the complainant had alleged). Thereafter, progress notes show that facility staff supported R1 with this care need.

Based on interviews and records, a preponderance of evidence does not exist to prove that Licensee did not meet R1’s care need. The allegation is therefore unsubstantiated.

An exit interview was conducted with Turner, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC9099 (FAS) - (06/04)

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