374604441-2-9-2024-08-AS-SJAB-D2MV6W-20240220151012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 02/09/2024
Date Signed: 02/09/2024 03:56:16 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
01/05/2024 and conducted by Evaluator Mark Mandel

COMPLAINT CONTROL NUMBER: 08-AS-20240105095151

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: 119	DATE:	02/09/2024
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Resident Services Director, Monica Maldonado		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Unlawful eviction

Staff not providing assistance resulting in multiple falls

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Mark Mandel conducted an unannounced visit to follow-up on a complaint investigation regarding the above-mentioned allegations. LPA was granted entry and met with Resident Services Director, Monica Maldonado. LPA stated the purpose of the visit and discussed the elements of the complaint with Director Maldonado. LPA delivered the investigative findings to Director Maldonado.

Today's visit consisted of resident and staff interviews and observing residents in care.

On 01/05/2024, the Department received a complaint alleging that facility staff processed an unlawful evicition. The Department's investigation consisted of facility visits, record reviews and interviews with staff, residents and outside sources. A review of records revealed Resident 1 (R1) was admitted to the facility on 06/29/2023 and observations and interviews with staff and R1 revealed R1 still lives at the

(Cont. on LIC9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Mark Mandel	TELEPHONE: 619-990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

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-20240105095151

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: 02/09/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Cont. from LIC9099)

facility and was not given a 30-Day Eviction Notice, rather, R1 was verbally told by Staff 1 (S1) that they were being evicted. S1 stated the the eviction letter is being worked on, but needs the approval of the facility's corporate office.

S1 said the main reason R1 was being evicted was for non-compliance with general policies of the facility as detailed in the Residence and Care Agreement, which R1 signed. Specifically, S1 stated that R1's behavior poses a danger to themselves or others at the Community and R1 has been verbally abusive to staff. Records reviewed and staff interviews corroborate R1's non-compliance with facility policies. Additionally, a review of medical records also reveal a history of non-compliant behavior.

S1 added that R1 has also exhibited a change in condition since first being admitted to the facility. Multiple medical reports also document a recent change in R1's condition when these reports are compared to the Physician's Report completed in June 2023 when R1 was admitted to the facility. The medical records also reveal that R1 did not complete recommended physical and occupational therapy referral programs at rehabilitation and skilled nursing facilities. They also show, along with facility records, that R1 discharged themselves from medical facilities against medical advice.

It was also alleged that facility staff was not providing assistance resulting in multiple falls, however, interviews conducted with staff and residents did not support the allegation. Resident 2 (R2) stated staff are very helpful and that she has never seen an occasion where staff did not help someone when they needed it. Resident 3 (R3) also said that he was happy with facility staff and that they provide him the assistance he needs and he has never seen an occasion when staff have not helped a resident who needed it. Staff 3 (S3) said she helps residents when they fall and has never heard that staff do not assist residents when they need help. Moreover, R1 stated they do not need help with anything, except garbage and acknowledged that they don't call staff when they need assistance and don't use an emergency alert device that the facility offers all residents. The availability of an emergency alert device for all residents was confirmed by facility records and Resident 4 (R4), who said he has one that facility staff provided. Also, Staff 2 (S2) stated that

(Cont. on LIC9099)

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Mark Mandel	TELEPHONE: 619-990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20240105095151

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: 02/09/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Cont from LIC9099)

R1 insists that they are independent, which corroborates R1's statement that they, "do not need help with anything." In addition, S1 stated that R1 refused a previous offer from S1 to move into the section of the facility that offers a higher level of care that could meet R1' s needs. Now, however, S1 stated the facility no longer has room for R1 in the section of the facility that could meet the new level of care R1 needs. Moreover, S1 stated R1's non-compliant behavior requires that the eviction process proceed.

Based on the interviews conducted and records obtained and reviewed, the allegations that facility staff processed an unlawful eviction and were not providing assistance resulting in multiple falls, are Unsubstantiated, as the preponderance of evidence standard was not met. An exit interview was conducted with Resident Services Director, Monica Maldonado. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to Director Maldonado, and their signature on this report confirms receipt of the report. .

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Mark Mandel	TELEPHONE: 619-990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3