374604083-12-10-2025-08-AS-SJAB-DQKMQ9-20260122084819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604083
Report Date: 12/10/2025
Date Signed: 12/10/2025 05:54:43 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
12/08/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20251208082541

FACILITY NAME:	MONTERA, THE		FACILITY NUMBER:	374604083
ADMINISTRATOR:	EMELY TURNER		FACILITY TYPE:	740
ADDRESS:	5740 LAKE MURRAY BLVD		TELEPHONE:	(619) 832-2599
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	225	CENSUS: 175	DATE:	12/10/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Emily Turner, Executive Director		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

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Staff did not assist resident in the shower
Due to staff neglect, resident fell in the shower sustaining an injury
Staff did not seek timely medical care for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA Amy Rodgers) conducted an unannounced visit to invistigage and deliver findings regarding a complaint received on 11/30/2025 involving Resident #1 (R1). LPA introduced herself and disclosed the purpose of the visit to the Emily Turner, Executive Director

The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, the resident, relevant outside sources, and records review.

The complaint alleged that staff failed to assist the resident during a shower, due to staff neglect, resident fell in the shower sustainging an injury, and that staff did not seek timely medical care. More specifically, the reporting party (RP) stated that the caregiver was not standing near the shower and did not intervene when the resident #1 (1) began to lose their balance, resulting in a fall with minor bleeding. It was further alleged that staff failed to assess or provide medical care following the incident.
(Continued on LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

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-20251208082541

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: 12/10/2025

NARRATIVE

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(Continued from Lic9099)

Staff interviews revealed that the caregiver was positioned near the bathroom shower, consistent with the resident’s care plan and facility protocols. The caregiver responded when called for assistance. Staff interviews reveal medical care following the incident was provided. Resident #1(R1) interview confirmed that the caregiver was present and responded, and that they were medically evaluated and received medical assistance following the incident. Records review of service plan (dated 1/14/2025), showed that the facility was providing care consistent with the resident’s plan. Further review of documentation revealed R1 received a medical evaluation after incident. Interview with an outside source indicated no concerns with the health and safety of the resident and an understanding of the facility’s policies regarding care and supervision. LPA observations confirmed the studio layout supports caregiver proximity and that the resident was ambulatory and not in distress.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegations are UNSUBSTANTIATED.

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

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

LIC9099 (FAS) - (06/04)

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