374604441-6-20-2023-08-AS-SJAB-D3YLP3-20240403085513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 06/20/2023
Date Signed: 06/20/2023 05:05:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
06/12/2023 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20230612151814

FACILITY NAME:	MONTE VISTA VILLAGE SENIOR LIVING		FACILITY NUMBER:	374604441
ADMINISTRATOR:	MARKOVICH, PAUL		FACILITY TYPE:	740
ADDRESS:	2211 MASSACHUSETTS AVENUE		TELEPHONE:	(619) 465-1331
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	219	CENSUS: 128	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Adrian Guillen, Executive Director		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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-Licensee Violated Eviction Procedures
-Licensee Violated Resident's Personal Rights Regarding Rent Increase Notice

INVESTIGATION FINDINGS:

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On 6/20/2023, at about 2:30 PM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced complaint investigation visit to the facility regarding the aforementioned complaint allegations. After introducing himself, presenting his department identification, LPA was granted entry into the facility. LPA met with Adrian Guillen, Executive Director, to whom the purpose of the visit was discussed.

It was alleged the facility violated eviction procedures and Resident 1's (R1) personal rights related to notification of rate increases.

The Department’s investigation into this matter consisted of interviews with staff and outside sources and record reviews. Interviews and facility and resident records provided sufficient evidence that the facility did in fact serve R1 with a 30-day eviction notice and level of care increase notice. Record reviews produced evidence that both notices were appropriate and in accordance with Title 22 Regulations as well as R1's Admission Agreement.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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-20230612151814

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MONTE VISTA VILLAGE SENIOR LIVING	FACILITY NUMBER: 374604441
	VISIT DATE: 06/20/2023

NARRATIVE

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The Department has investigated the allegations listed above. Based on evidence obtained, including interviews and records reviewed, the above allegations are determined to be unsubstantiated and do not meet the preponderance of the evidence standard. An exit interview was conducted with Executive Director, Adrian Guillen and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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