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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 11/06/2024
Date Signed: 11/06/2024 04:54:05 PM

Unsubstantiated


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
08/02/2024 and conducted by Evaluator Amy Domingo
COMPLAINT CONTROL NUMBER: 08-AS-20240802090547
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: 197DATE:
11/06/2024
UNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Robin Mendez Director of Health ServicesTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Resident sustained a pressure injury due to staff neglect.
Staff did not ensure that resident's room was clean.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Robin Mendez, Director of Health Services.

The Department’s investigation consisted of facility and outside records review, interviews with staff, residents and outside sources.


On 08/02/2024, Community Care Licensing (CCL) received a complaint alleging resident sustained a pressure injury due to staff neglect and staff did not ensure that resident's room was clean.

(Continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
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-20240802090547
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: 11/06/2024
NARRATIVE
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It was alleged that Resident 1 (R1) (Please refer to LIC811 confidential names list), sustained a pressure injury due to staff neglect.  R1 was admitted to the facility on 02/18/2022. On 04/17/2024 R1 was admitted on to hospice care.  Review of R1's records showed that throughout R1's stay at the facility the staff communicated with the medical doctor when there were any changes of R1's condition. Outside source 1 (OS1) and outside source 2 (OS2) were interviewed and there were no concerns regarding R1's care throughout R1's stay at the facility.  Outside source 3 (OS3) was interviewed and medical changes were communicated and addressed in a timely manner.  Review of hospice documentation revealed medical staff and hospice staff closely monitored R1 medical changes including any skin issues.  OS1 was interviewed and stated that all staff communicated well with OS1 regarding R1's daily condition and changes.  Staff members including management staff were readily available to communicate with and there were no concerns regarding R1's care. Staff 1 (S1) was interviewed and reviewed R1's plan of care and medical records which showed continuous medical care by staff and hospice staff that addressed R1's changes in medical needs. Staff 2 (S2) was interviewed and reviewed schedules of staff and hospice staff visits for R1. 

It was alleged that staff did not ensure that resident's room was clean.  On 8/7/24 LPA Domingo toured the facility and a few rooms, there were observations of clean rooms.  The rooms were not cluttered,  the trash cans were empty,  the floors were clean and there were no odors.  On 8/16/24 LPA  toured the facility and a few rooms, there were observations of clean rooms.  The rooms were not cluttered,  the trash cans were empty,  the floors were clean and there were no odors.  On 9/18/24 LPA toured the facility and observed the room to be clean. The rooms were not cluttered, the trash cans were empty, the floors were clean and there were no odors.  OS1 and OS2 were interviewed and did not observed R1's room to be cluttered or odorous.  OS1 and OS2 stated that the facility was well kept and had no concerns regarding the facility or R1's room cleanliness. Outside source 4 (OS4) was interviewed and there were no concerns regarding the facility's cleanliness.  OS4 stated during visits to the facility the staff were always actively cleaning and disinfecting common and private areas.

Based on LPA's interviews with staff, outside source interviews, and record reviews there is not a preponderance of evidence to prove alleged violation(s) occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Robin Mendez, Director of Health Services, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC9099 (FAS) - (06/04)
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