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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 03/12/2025
Date Signed: 03/12/2025 07:00:33 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
09/06/2024 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20240906100527
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:
03/12/2025
UNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Executive Director (ED) Adrian GuillenTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff did not ensure that facility is delivering hot water.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to deliver the investigative finding regarding the above-mentioned allegation. LPA was met by the front Receptionist Hubbard, identified herself, and was granted entry into the facility. LPA then met with Executive Director (ED) Guillen, who was explained the purpose of the visit.

The Department's investigation consisted of staff and resident interviews and a facility tour.

On September 6, 2024, the Department received a complaint that alleged the faucets in the women’s restroom sinks located in the facility’s auditorium, which was temporarily used as the dining area for residents in care, were not supplying hot water. An interview with the ED revealed that the facility was building a new memory care unit that resulted in a temporary relocation of the residents' dining area. Interviews conducted with residents in care did not have knowledge of the faucets without hot water in the women’s auditorium restroom. However, during LPA’s facility tour, accompanied by the ED, it was corroborated that the women’s restroom faucets in the auditorium were not producing hot water.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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-20240906100527
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: 03/12/2025
NARRATIVE
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Once the violation was confirmed, the ED contacted the on-site Director of Maintenance (DOM) who came, diagnosed, and fixed the problem during LPA’s visit. The ED and DOM both revealed they were unaware that the valve to the hot water in the women’s restroom had been turned off, and both felt it was most likely due to construction workers forgetting to turn the hot water back on when they finished working.

Based on a facility tour and staff interviews, the allegation was determined to be Substantiated. A Substantiated finding means the preponderance of evidence has been met. Deficiency is cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on the LIC 9099-D. An exit interview was conducted with ED Guillen, and he was informed that a copy of the reports will be provided at the conclusion of the visit. Signature below confirms receipt of the reports.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20240906100527
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: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2025
Section Cited
CCR
87303(e)(6)
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Maintenance and Operation(e)Water supplies and plumbing fixtures shall be maintained as follows (6)...hand washing...facilities shall be maintained in operating condition. ...equipment shall be provided in facilities accommodating...based on the residents' needs.

This requirement was not met as evidenced by:
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Facility staff fixed the faucets during the LPAs initial visit on 9/6/2024.

Deficiency is cleared.
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The facilities faucet used for hand washing were not providing hot water.


This posed a potential health risk to 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: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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
09/06/2024 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20240906100527

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:
03/12/2025
UNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Executive Director (ED) Adrian GuillenTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff served food that was contaminated to the residents in care.
Staff did not ensure the bathroom toilet was repaired.
Staff did not prevent the facility from being unsanitary.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to deliver the investigative findings regarding the above-mentioned allegations. LPA was met by the front Receptionist Kathy Hubbard, identified herself, and was granted entry into the facility. LPA then met with Executive Director (ED) Adrian Guillen, who was explained the purpose of the visit.

The investigation included resident and staff interviews, a facility tour, and LPA observations.

It was alleged staff served food that was contaminated (by construction occurring at the facility) to the residents in care, staff did not ensure the bathroom toilet was repaired, and the facility was unsanitary. Regarding contaminated food being served, a facility tour revealed the kitchen was protected by plastic barriers prohibiting any dust or remnants from entering the kitchen during the renovation. Kitchen staff were observed wearing all the appropriate protective gear to prevent cross contamination of the residents' meals. The kitchen was observed to be sanitary, appliances were in good repair, the food was appropriately stored and labeled, and there were no signs observed of dust or remnants as a result from construction.

This is an amended version of the original report dated 3/12/2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20240906100527
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: 03/12/2025
NARRATIVE
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Regarding the facility toilet, an interview conducted with the Executive Director (ED) revealed the facility had on-site maintenance to address any issues, such as disrepair, as they arise. Interviews conducted with the Director of Maintenance (DOM) and residents in care corroborated the facility is kept in good repair by timely on site maintenance. An interview conducted with Staff 1 (S1) regarding the complaint allegations revealed they had worked at the facility for approximately 1.5 years. The Assisted Living (AL) unit of the facility had its own dining area, where the interview took place, however the food is delivered from the same kitchen. S1 has not had any complaints regarding dust in meals or contaminated food by the residents.


An interview conducted with Resident 1 (R1) had lived at the facility for approximately one year. R1 revealed they never experienced any issues with the meals served at the facility. LPA asked specifically if they had dust in their food/meals due to the current renovations occurring at the facility, R1 replied "no". LPA also inquired about the facility communal bathroom in the auditorium R1 said they had never used it but reported not having any issues with the facility amenities/appliances in general. R1 reported they were very happy with the facility and the facility staff. Additionally, an interview conducted with Resident 2 (R2) revealed they had lived at the facility for approximately 7 years. R2 stated they have never encountered dust particles in their meals or issues with the food at the facility. R2 revealed that the facility is always very clean, they had not observed any disrepair or uncleanliness. R2 also stated the staff bend over backwards to help the residents. Their only complaint was that the construction was taking a little longer than they expected. R3 lived in the independent living building at the facility. LPA observed R3's room to have a layout as a large open apartment, including a living room area, bedroom, kitchenette, and bathroom. LPA observed R3's room to be well kempt and sanitary. R3 reported no issues with the cleanliness of their room or the facility's communal rooms or facility grounds. LPA checked R3's toilet, and it was functional with no issues.

Based on the interviews conducted and observations, the above listed allegations were determined to be Unsubstantiated, as the preponderance of evidence standard was not met. An exit interview was conducted with ED Guillen who was informed that a copy of the reports will be provided at the conclusion of the visit. Signature below confirms receipt of the reports.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5