374604441-5-6-2024-08-AS-JLOT-D58RN3-20240513130937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 05/06/2024
Date Signed: 05/06/2024 10:52:55 AM

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
02/28/2024 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20240228112500

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: 115	DATE:	05/06/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive Director Adrian Guillen		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Licensee did not comply with the admission agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Adrian Guillen.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that the Licensee did not comply with the admission agreement, specific to laundry services. Review of a random sampling of residents’ admission agreements revealed that sometime between 2021 and 2022, the facility began using a different version of their admission agreement. Admission agreements signed prior to the change indicated that the facility provided personal laundry services for a fee and made washing and drying machines available for resident use. Review of the facility’s rate list as of 2021, revealed that the facility did not have a monetary charge for additional personal laundry loads.
Continued on LIC9099-C page...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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-20240228112500

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: 05/06/2024

NARRATIVE

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Review of the admission agreements signed after the change included the statement that the facility provided weekly laundering of linens and towels and that personal laundry was available at an additional charge. Review of the facility’s rate list as of 2023 revealed that the facility did not have a description of personal laundry service listed and additionally, did not have a monetary charge for additional personal laundry.

Interviews with residents, staff, and outside sources and review of the written notice revealed that on December 20^th, 2023, the facility sent out a written notice to all residents stating that starting on March 1^st, 2024, the facility would begin charging for the laundering of resident’s personal clothing items. The notice stated that 1 load of residents’ personal laundry washed per week would be charged at $100 a month, and two loads of laundry per week would be charged at $200 per month. The written notice specifically stated that bed linens would continue to be provided in the standard housekeeping service but that daily trash pickup and bed-making would no longer be provided. Review of the notice revealed that there was no portion of the written notice for residents to sign or any language stating that the notice was considered an amendment to the admission agreement.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

An exit interview was conducted with Executive Director Adrian Guillen, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240228112500

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: 05/06/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/17/2024 Section Cited CCR 87307(a)(3)(F)	1 2 3 4 5 6 7	87307 Personal Accommodations and Services (a)(3) …if the resident is unable or chooses not to provide them, the licensee shall assure the provision of: (F) Basic laundry service (washing, drying, and ironing of personal clothing). This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Per Executive Director, no residents have been charged for the washing of personal laundry as of 5/6/2024. Executive Director will contact Corporate to gain approval to send a notice via mail to all residents stating that personal clothing will be included in the basic laundry service.
	8 9 10 11 12 13 14	Based on interviews and records review, the licensee did not ensure that residents were provided with personal clothing laundry as part of the basic services. This poses a potential personal rights risk to 115 of 115 residents in care.	8 9 10 11 12 13 14	Executive Director will provide the Department with a copy of the notice by POC due date of 5/17/2024.
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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.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

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