374604083-7-18-2025-08-AS-SJAB-DJSVM6-20250721163302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 07/17/2025
Date Signed: 07/18/2025 09:58:07 AM

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
05/01/2025 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20250501100721

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: 183	DATE:	07/17/2025
		UNANNOUNCED	TIME BEGAN:	02:31 PM
MET WITH:	Gerrit Hoevers Director of Environment Service		TIME COMPLETED:	03:12 PM

ALLEGATION(S):

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The licensee failed to protect the resident from harm.
The licensee failed to facilitate medical care for the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the findings in the above-mentioned complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Gerrit Hoevers Director of Environment Service.

During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents, and outside sources.
On May 1, 2025, the department received a complaint alleging that the licensee failed to protect the resident from harm.

LPA Domingo interviewed Outside Source 1 (OS1), and OS1 verified that the Resident 1 (R1) was being seen four (4) times a week or more when the open area was first observed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

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 3

Control Number 08-AS-20250501100721

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: 07/17/2025

NARRATIVE

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Continued from LIC9099

OS1 reviewed the documentation available to show the days and times R1 was visited and what treatment was completed. LPA Domingo interviewed Outside Source 2 (OS2), and they verified that R1 was being seen four (4) times a week or more when the open area was first observed.

OS1 reviewed the documentation available to show the days and times R1 was visited and what treatment was completed.

Outside Source 3 (OS3) was interviewed, and they stated that the facility and staff that cared for R1's wound care communicated any changes and provided updates regarding the progress of R1's wound care.

Records reviewed revealed the physician involved with R1's care was notified of the wound care and the progress of the wound. The records contained the type of wound care treatment and the description of the wound with each visit.

On May 1, 2025, a complaint was received alleging the licensee failed to facilitate medical care for the resident. Staff 1 (S1) was entering R1's room to administer bedtime medications. S1 observed that R1's family members were digitally removing R1's bowel movement. S1 told the family members to stop immediately. S1 explained that there were no physician orders for anyone to remove bowel movements from R1. S1 observed R1 to be moaning and grimacing.

Staff 2 (S2) was interviewed, and they stated that for the safety of R1, they will be requesting the family members who were in the room only to visit R1 in the common areas. At no time did S2 deny family members' visitation for R1. S2 explained to the family members that the visitation restrictions were implemented due to the family providing care to R1 without a physician's order. Records reviewed revealed there was no physician's order to remove R1's bowel movements digitally.

Outside source 4 (OS4) was interviewed, and they agreed that due to the family members' actions, they should only visit R1 in the common areas.

Records reviewed from the facility and Hospice, and all care providers provided the appropriate medical care for R1.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20250501100721

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: 07/17/2025

NARRATIVE

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Continued from LIC9099C 3 of 3

Interviews and records review did not support any evidence that the staff are not providing appropriate medical care for R1. Interviews with staff and outside sources revealed the licensee did not fail to facilitate medical care for the resident.

This agency has investigated the complaint alleging that the licensee failed to protect the resident from harm and the licensee failed to facilitate medical care for the resident. The Department has found that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report and licensee rights (LIC 9058 03/22) was provided. Gerrit Hoevers Director of Environment Service signature on this form confirms receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

LIC9099 (FAS) - (06/04)

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