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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 03/15/2024
Date Signed: 03/18/2024 09:28:09 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/08/2024 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20240308160149
FACILITY NAME:MONTE VISTA VILLAGE SENIOR LIVINGFACILITY NUMBER:
374604441
ADMINISTRATOR:ADRIAN GUILLENFACILITY TYPE:
740
ADDRESS:2211 MASSACHUSETTS AVENUETELEPHONE:
(619) 465-1331
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:219CENSUS: 117DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Executive Director (ED) Adrian GuillenTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Unlawful eviction.
Staff did not provide medical attention for resident.
Staff did not treat resident with dignity.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to conclude an investigation regarding the above-mentioned allegation. LPA was greeted by the Receptionist, Andrea Maldonado-Odgers, identified herself, and met with Executive Director (ED) Guillen and stated the purpose of the visit.

The Department's investigation included facility records reviews and staff and outside source interviews.

It was alleged facility staff did not seek medical attention to a Resident 1 (R1) in care after sustaining a fall. A facility and resident records review revealed on December 28, 2023, R1 sustained an unwitnessed fall at the facility and upon staff discovering that R1 had sustained a fall they called 911 and R1 was transferred to the hospital. Records also revealed on January 4, 2024, R1 left the hospital against medical advice and returned to the facility.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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 2
Control Number 08-AS-20240308160149
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MONTE VISTA VILLAGE SENIOR LIVING
FACILITY NUMBER: 374604441
VISIT DATE: 03/15/2024
NARRATIVE
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It was also alleged facility staff did not treat R1 with dignity. Facility staff, and R1's records revealed staff tried to assist R1 after sustaining a fall however R1 was resistant and cursed at staff. R1 was also resistant to accepting medical care. Resident records also revealed several prior attempts to assist R1 with their health conditions including seeking medical care and hospital admits.

Additionally, it was alleged facility staff served R1 an unlawful eviction. In regard to this allegation Community Care Licensing (CCL) unknowingly accepted this allegation when it was previously investigated and the Department rendered findings on January 8, 2024.[See LIC 811 for Confidential Names]

Based on records reviews and interviews, and an allegation previously investigated by the Department the above mentioned allegations were determined to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with ED Guillen was informed they will be provided a copy of this report and Licensee Rights (LIC 9058), whose signature below confirms receipt of these rights.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2