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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604083
Report Date: 05/24/2024
Date Signed: 05/30/2024 09:32:21 AM


Document Has Been Signed on 05/30/2024 09:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



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: 183DATE:
05/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Emily Turner Executive DirectorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced case management visit. LPA was granted entry into the facility by Emily Turner Executive Director, with whom she disclosed the purpose of the visit.

Today’s visit was in response to an incident which licensee self-reported via an LIC624 Incident Report received at the the Community Care Licensing Regional Office on May 22, 2024. The report described Resident #1 (R1 – See LIC811 Confidential Names List for identification), with possible financial abuse.

LPA briefly toured the facility, performed a welfare check on residents in care, interviewed resident and staff, and obtained copies of pertinent facility records. No deficiencies were observed or cited on this date.

An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22)  were left with the Executor Director, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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