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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604101
Report Date: 03/18/2022
Date Signed: 03/22/2022 10:25:25 AM

Document Has Been Signed on 03/22/2022 10:25 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MONTON RESIDENTIAL FACILITY INCFACILITY NUMBER:
374604101
ADMINISTRATOR:MONTON, LOIDAFACILITY TYPE:
735
ADDRESS:12323 JULIAN AVETELEPHONE:
(619) 749-4130
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 6CENSUS: 6DATE:
03/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Administrator, Loida Monton, Caregivers, Yolanda Bennett, and Filipina Cabalan TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required 1 - Year Visit. LPA was greeted by Caregiver, Yolanda Bennett, identified himself, and discussed the purpose of the visit. Caregivers, Yolanda Bennett, and Filipina Cabalan, conducted a tour of the facility with the LPA. Administrator, Loida Monton, arrived during the visit, and assisted with the tour.

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE (Personal Protective Equipment). Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. No deficiencies were observed during today's visit.

In accordance with the Department’s Infection Control program, the LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan (LIC 808).

An exit interview was conducted with Administrator, Loida Monton, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via electronic mail. A read receipt email confirms the documents were received by Administrator, Loida Monton.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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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