374604441-4-10-2026-08-AS-SJAB-DVZTR8-20260715145707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 03/26/2026
Date Signed: 04/10/2026 01:04:31 PM

Substantiated

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
02/11/2026 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20260211133115

FACILITY NAME:	MONTE VISTA VILLAGE SENIOR LIVING		FACILITY NUMBER:	374604441
ADMINISTRATOR:	ADRIAN GUILLEN		FACILITY TYPE:	740
ADDRESS:	2211 MASSACHUSETTS AVENUE		TELEPHONE:	(619) 465-1331
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	219	CENSUS: 111	DATE:	03/26/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Executive Director Adrian Guillen		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Licensee did not maintain facility in a state of good repair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Executive Director, Adrian Guillen.

On 2/11/25, it was alleged that the Licensee did not maintain facility in a state of good repair.

During the visit, the LPA toured the facility and was specifically observed the area of the facility that has a downward tilt and at the lowest area there are resident housing. Staff 1 (S1) stated that the facility has been aware of the possibility of flooding because of the downward flow of water and the resident housing being on the lower area of possible flooding. The facility was built many years ago and there has been discussions about how to remedy the situation.

(Continued on LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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-20260211133115

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: MONTE VISTA VILLAGE SENIOR LIVING	FACILITY NUMBER: 374604441
	VISIT DATE: 03/26/2026

NARRATIVE

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(Continued from LIC9099)

Currently the facility added another water drain and there are multiple water pumps to aid in moving draining water away for the residents housing area. There are also multiple sandbags placed in front of the entrances of the residents housing to prevent water from entering the resident housing.

Three (3) residents were interviewed; both denied experiencing any flooding in their housing. The residents interviewed were complementary of the facility and maintaining the grounds during the episodes of increase rainfall. The third resident interviewed had flooding in their housing unit that caused damage to their belongings.

Outside source 1 (OS1), reported no concerns observing flooding with the residents housing. Outside Source 2 (OS2) stated that they observed the damage of flooding in a resident's room during high rainfall.

A review of facility records, including incident logs, and communication notes, confirm on going repairs to the facility and grounds to make sure the facility is well maintained. The pumps were used during the month of December 2025 for the increase notice of rain, but removed before the January 2026 rains. The facility was aware of the potential flooding of the housing units in the area to remedy flooding of the residents housing. The pumps were not in place when the heavy rain caused flooding in the resident housing.

Based on records and interviews, a preponderance of evidence exists to show Licensee did not maintain facility in a state of good repair. Therefore, the allegation is deemed substantiated, and one (1) deficiency was cited for it per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Executive Director Adrian Guillen, 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 Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20260211133115

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: MONTE VISTA VILLAGE SENIOR LIVING	FACILITY NUMBER: 374604441
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/27/2026 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation: “(a) The facility shall be…safe… and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.” This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to have pumbs in place prior to any reports of rain by POC due date.
	8 9 10 11 12 13 14	Based on interviews and LPA observation, Licensee did not maintain the facility’s outdoor draining system in safe and good repair at all times. This posed a potential safety risk to 1 of 111 resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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