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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 03/10/2025
Date Signed: 03/10/2025 06:41:12 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
12/20/2024 and conducted by Evaluator Juliana Barfield
COMPLAINT CONTROL NUMBER: 08-AS-20241220150424
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: 111DATE:
03/10/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Adrian Guillen and Concierge Kathryn HubbardTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Staff do not ensure that the facility is maintained in good repair.

Staff do not ensure that facility is maintained at a comfortable temperature for residents.

Staff do not ensure that facility is maintained sanitary.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced subsequent complaint visit regarding the above-mentioned allegations. LPA was met by, identified herself to, and discussed the purpose of the visit with Director Adrian Guillen. Concierge Kathryn Hubbard later joined the visit to sign documents.

The Department's investigation consisted of record review, interviews with facility staff and residents, and included LPA observations. It was alleged that the facility is not maintained in good repair. During LPA tour of lounge restrooms it was demonstrated the toilets were not working. Resident and staff interviews confirmed that the toilets were not working. Staff indicated that the bathroom had new plumbing but a piece of metal was lodged in the plumbing pipes and backing up water for the last three months so the bathrooms were closed.


Substantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
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 5
Control Number 08-AS-20241220150424
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: 03/10/2025
NARRATIVE
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The electric sliding glass doors on the south and north entrances to the lounge and dining rooms were not in operating condition. Facility staff and LPA entered the building by staff manually pulling the north door open. Staff said the electricity to the door was not working. Staff interviews indicated that the building is open from 7:00am - 6:30pm. LPA observed brown stains in the white ceiling panels in the south dining area. Resident interviews asserted that there were leaks in the ceiling over the past year when it rained. On a subsequent LPA visit, three buckets were observed placed on the floor in the south dining area. LPA noted water in the buckets and drops coming from the ceiling. The ceiling panels were opened up above these areas and the pipes were exposed. Furthermore, LPA observation and resident interviews showed the central overhead light in the auditorium did not work. A tour of the auditorium bathrooms also showed a loose toilet seat and a stall door that could not be locked. LPA observed that the sink faucet in lounge/dining area and auditorium restrooms do not produce hot water.

It was also alleged that the facility is not maintained at a comfortable temperature for residents. At the time of the visit, a working thermostat was not present in the south dining room or lounge area. LPA experienced the areas to be cold and not at a comfortable temperature. Residents doing an activity in the lounge were dressed in jackets and blankets were on resident shoulders. Resident interviews stated the area was cold. Staff interviews stated a new HVAC system needs to be installed but it would be a month before it was completed. Furthermore, LPA observed four residents playing cards in the auditorium and the room was not at a comfortable temperature. The thermostat showed the temperature to be 60 degrees. Resident interviews confirmed that the temperature of the room was cold for them.

It was alleged that the facility is not maintained sanitary. LPA observed brown water and dirt around the lounge area restroom toilets and around the drain in the restroom. Bathroom surfaces were covered with a layer of powder material. LPA also observed food crumbs on the floor of the south dining area and dirt on the auditorium floor.



The Department has investigated the above-mentioned allegations and has found that based upon LPA observations and interviews, a preponderance of evidence exists to support the allegations. Therefore, these allegations are deemed substantiated.

Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D).
An exit interview was conducted with Concierge Kathryn Hubbard, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/20/2024 and conducted by Evaluator Juliana Barfield
COMPLAINT CONTROL NUMBER: 08-AS-20241220150424

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: 111DATE:
03/10/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Concierge Kathryn HubbardTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Facility smells malodorous.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced subsequent complaint visit regarding the above-mentioned allegation. LPA was met by, identified herself to, and discussed the purpose of the visit with Director Adrian Guillen. It was alleged that the facility was malodorous. The Department's investigation consisted of a tour of the facility, interviews with staff, residents, and outside sources. During a tour of the facility, no malodors were noticed. Interviews with staff and residents revealed no malodors have been noted.
Based on LPA observations, interviews with residents and staff, the facility was not experienced to be malodorous, therefore the allegation is unsubstantiated.

An exit interview was conducted with Kathryn Hubbard to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. Her signature on this form acknowledges receipt of these rights.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20241220150424
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: 03/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2025
Section Cited
CCR
87303(a)
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MAINTENANCE AND OPERATION
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and premployees and visitors. The procedures for the safety and well-being of residents, equirement was not met as evidenced by:
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Licensee stated the HVAC system, restroom plumbing, and entry/exit sliding glass doors are repaired. Licensee will repair ceiling's plumbing by the POC date of 04/09/2025. Licensee to send receipts of repairs and photos of the ceiling repair.
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Based on LPA observations and interviews, the licensee did not maintain facility ceiling, bathrooms, and sliding doors in good repair. This posed a potential risk to 111 of 111 residents in care.
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residents in care.
Type B
03/31/2025
Section Cited
CCR
87303(b)(1)
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MAINTENANCE AND OPERATION
(b)(1) The facility shall heat rooms that residents occupy to a minimum of 68 degrees F.
This requirement was not met as evidenced by:
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Licensee confirmed the lounge/dining HVAC is repaired. Licensee to set auditorium/lounge thermostat at at least 68 degrees, one hour before resident activities. Licensee to send photo of sign at thermostats asking residents to call staff to set temperature by 04/09/2025.
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Based on LPA observations and interviews, licensee did not maintain a comfortable temperature when the facility common areas were observed at 60 degrees F. This posed a potential health risk to 111 of 111 residents in care.
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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: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 08-AS-20241220150424
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: 03/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/31/2025
Section Cited
CCR
87303(a)(1)
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MAINTENANCE AND OPERATION
Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary and odorless condition.
This requirement was not met as evidenced by:
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Licensee will retrain staff to clean dining area floors after meals by sweeping and mopping floors. Licensee to assign staff to do scheduled cleanings of auditorium. A signed training log with class description, staff name and signature is due by POC date 04/09/2025 for each area.
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Based on LPA observations and interviews, the licensee did not ensure facility floors were maintained in a clean, sanitary condition. This posed a potential safety risk to 111 of 111 residents in care.
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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: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5