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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336424970
Report Date: 08/08/2022
Date Signed: 08/08/2022 04:04:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2022 and conducted by Evaluator Jesse Gardner
COMPLAINT CONTROL NUMBER: 18-AS-20220805105246
FACILITY NAME:MONTAGE MANORFACILITY NUMBER:
336424970
ADMINISTRATOR:CYNDY ZAECHFACILITY TYPE:
740
ADDRESS:69-920 MATISSE RDTELEPHONE:
(760) 699-5090
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 6DATE:
08/08/2022
UNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Vanessa Franco, House ManagerTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff handled resident in a rough manner.
Staff caused injury to resident.
Staff does not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to investigate the above allegations. LPA identified himself and met with House Manager Vanessa Franco who accompanied LPA on a tour of the facility.

Regarding the allegation, "Staff handled resident in a rough manner". LPA found that through interviews with S1, S2, and R1, LPA did not find that staff handled resident in a rough manner during an incident which occurred in June, 2022.

Regarding the allegation, "Staff caused injury to resident." During the aforementioned incident in June, 2022, LPA found that while S2 was helping R1 get dressed for the day, during the process, an earring was dislodged from R1's ear. The manner in how it was dislodged was not determined by this LPA. Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
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 18-AS-20220805105246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MONTAGE MANOR
FACILITY NUMBER: 336424970
VISIT DATE: 08/08/2022
NARRATIVE
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Regarding the allegation, "Staff does not treat resident with dignity and respect." Through interviews with residents, and witnesses, LPA found that R1 is treated with dignity and respect.

Due to interviews, and information obtained, LPA was not able to corroborate the allegations; therefore, the complaint is found to be UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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.

An exit interview was conducted where a copy of this report was discussed with and provided to Vanessa Franco.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2