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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202356
Report Date: 01/09/2025
Date Signed: 01/09/2025 11:41:54 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2023 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20231206120806
FACILITY NAME:MONTECITO MANORFACILITY NUMBER:
445202356
ADMINISTRATOR:JOLENE SICLEYFACILITY TYPE:
740
ADDRESS:311 MONTECITO AVE.TELEPHONE:
(831) 724-3055
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:85CENSUS: 54DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Ivonne SanchezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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On 1/9/2025, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Assistant Manager Ivonne Sanchez and LPA explained the purpose of the visit.

Regarding the allegation of staff do not safeguard resident's personal belongings, reporting party (RP) stated that around November 30, 2023, resident (R1) had money stolen, approximately $80. R1 also had a new jacket stolen within the last week. RP have purchased name labels, and RP sews them into all R1s clothing, however, his clothing frequently is taken and not returned.

During an interview with RP, it was shared that R1 is visually impaired, so often he/she thinks things are missing. RP went and visited and looked for the $100 and jacket, but I did not find it. There is someone who lives there as well. One of the staff people told RP that R1 was showing the money to this other resident. RP said staff saw R1 showing the money. RP thought it might be a resident rather than a staff person. R1 also has lost hearing aids – one pair, wears one in each ear. The hearing aids went missing quite a while ago about a year ago. R1 reported the hearing aids missing to the facility. They said they will look and we don’t know what happened. They said they are not liable.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
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 2
Control Number 26-AS-20231206120806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: MONTECITO MANOR
FACILITY NUMBER: 445202356
VISIT DATE: 01/09/2025
NARRATIVE
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LPA Marrufo was able to interview three staff members. S1 stated that he/she spoke with RP and RP said on R1s birthday they brought him/her money. S1 didn’t see it. S1 told RP that they should not be giving him money because he/she gives out the money to other people. R1 gives R2 money to buy sodas. When R1 has money, R1 always wants R2 to buy a soda. Sometimes we find shirts of R1 in other places and R1 gets stressed out. R1s black jacket is the one in the room. S1 have seen him with a brown jacket, that black puffy jacket, and a blue one that R1 has on right now. S1 haven’t seen R1s hearing aids.

According to S2, around November 26th or 27th, the receptionist mentioned to S2 that R1 had $80 stolen. We told them we would do everything we can to investigate. We told RP in the future to not give R1 money personally but to give it to us so we can keep it in the safe. We looked at the security camera and we did not see anyone leave the room. We asked R2 if he/she took the money and he said no. We don’t know if R1 gave R2 money to go to the store. We asked R2 if he/she did and said no, but R1 does not always remember everything. S2 had never seen that black puffy jacket before. S2 has seen one with a Raiders jacket and a blue jacket and a red one. R1 had about 3-4 different ones. R1 has been missing the hearing aids for about a year. We have notified R1s family about that. R1 keeps taking them out and won’t let the staff put them on the charger. R1 would not let the staff take them out of his/her ears at night to put them on the charger. They went missing for a long time. He had not ordered new ones that I know of.

LPA Marrufo also interviewed R2 and it was mentioned that R1 never gave money to buy anything for him/her.

Based on records review, the jacket and money was not logged on either the Safeguard for Properties and Valuables form nor the money logged on Cash resources log. Additionally, according to the theft and loss policy of the facility, included in the admissions agreement, the facility reserves the right to review aII valuables retained by the Resident and accepts neither responsibility not liability for loss of money or valuables unless they are deposited and inventories with Montecito Manor for safekeeping. Residents are not allowed to bring in valuables. Montecito Manor requires the Responsible Party provide a complete inventory of all personal property (brought into Montecito Manor) and that no jewelry be brought in over $100 in value.

Based on interviews and ecords review, the department has determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
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