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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202356
Report Date: 03/08/2025
Date Signed: 03/16/2025 02:29:00 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
04/29/2022 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220429092911
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: 52DATE:
03/08/2025
UNANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:Jolene Sicley TIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Staff handle residents in a rough manner
Staff does not treat residents with respect
Resident's toileting needs are not being met
INVESTIGATION FINDINGS:
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On 03/08/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Jolene Sicley and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings.
Current census was 52. A brief interview with FDA Sicley was conducted.
Allegation: Staff handle residents in a rough manner
It was alleged that staff handle residents in a rough manner. During the course of this investigation LPA conducted staff and resident interviews. Based on interviews conducted with 5 staff members. 5 out of 5 staff members denied handing any residents in a rough manner. 5 out 5 of staff members deny seeing any other staff members handling any residents in a rough manner. 5 out 5 staff members also deny any reports regarding any staff members handling residents in a rough manner. An interview with 8 residents were conducted. 8 out 8 residents deny being handled in a rough manner. 8 out 8 residents deny hearing or seeing any other residents being handled in a rough manner. Based on the information gathered, it is unclear that the staff handled the residents in a rough manner.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
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-20220429092911
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: MONTECITO MANOR
FACILITY NUMBER: 445202356
VISIT DATE: 03/08/2025
NARRATIVE
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Allegation: Staff does not treat residents with respect

It was alleged that staff does not treat residents with respect. During the course of this investigation, LPA conducted staff and resident interviews. Based on interviews conducted with 5 staff members, 5 out 5 staff members denied not treating the residents with respect. 5 out 5 staff members deny seeing any staff members not treating residents with respect. An interview with 8 residents were conducted. 8 out 8 deny not being treated with respect and report that they enjoy the staff at the facility. Based on the information gathered, it is unclear that the staff does not treat residents with respect.

Allegation: Resident's toileting needs are not being met

It was alleged that the resident’s toileting needs are not being met. During the course of this investigation, LPA conducted interviews and reviewed facility records. Based on interviews conducted, 5 out 5 staff members deny not meeting residents toileting needs. 5 out 5 staff members stated that sometimes it may be difficult to change the residents however, most of the time it is met. An interview with 8 residents were conducted. 5 out 8 residents needed assistance with toileting needs and denied that their needs were not being met. A review of the residents shower logs and daily notes were conducted. Which did not indicate if the facility did not meet resident’s toileting needs. Based on the information gathered, it was unclear of the resident’s toileting needs were not being met.

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: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2