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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202509
Report Date: 11/09/2024
Date Signed: 11/09/2024 12:49:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/18/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20231218162242
FACILITY NAME:VILA MONTEFACILITY NUMBER:
435202509
ADMINISTRATOR:NICHOLAS INNEHFACILITY TYPE:
740
ADDRESS:17090 PEAK AVENUETELEPHONE:
(408) 500-2693
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:28CENSUS: 25DATE:
11/09/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nicholas InnehTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Staff did not prevent resident from making threatening comments towards another resident
INVESTIGATION FINDINGS:
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On 11/09/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with staff and explained the purpose of the visit. LPA learned that the Facility Designated Administrator (FDA) was unable to visit the facility at this time, however, LPA was able to contact FDA via phone and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.
Current Census was 25. A brief interview with FDA Inneh was conducted.
Allegation: Staff did not prevent resident from making threatening comments towards another resident
It was alleged that staff did not prevent resident from making threatening comments towards another resident. Based on interviews conducted the facility conducted an internal investigation and found that the staff member alleged to have stated a threatening denied that they make a threatening comment. It was learned that R1 would lie and would make inappropriate comments towards staff.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024
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 26-AS-20231218162242
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: VILA MONTE
FACILITY NUMBER: 435202509
VISIT DATE: 11/09/2024
NARRATIVE
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An interview with 3 additional staff members were conducted. 3 out 3 staff members denied making inappropriate comments towards staff or hearing others make inappropriate comments. An interview with 5 residents were conducted. 5 out of 5 residents deny that staff make threatening comments towards others. Based on the information gathered, it is unclear if staff did not prevent residents from making threatening comments towards another resident.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.



There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2