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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604441
Report Date: 07/15/2025
Date Signed: 07/15/2025 11:06:29 PM

Unsubstantiated


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
02/27/2023 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20230227134000
FACILITY NAME:MONTE VISTA VILLAGE SENIOR LIVINGFACILITY NUMBER:
374604441
ADMINISTRATOR:MARKOVICH, PAULFACILITY TYPE:
740
ADDRESS:2211 MASSACHUSETTS AVENUETELEPHONE:
(619) 465-1331
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:219CENSUS: 103DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director (ED) Adrian GuillenTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Facility is not following proper Covid-19 infection control protocols.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver findings regarding the above-mentioned complaint allegation. LPA met with Executive Director (ED) Adrian Guillen, identified herself, and stated the purpose of the visit.

The Department's investigation consisted of staff and resident interviews and records reviews, and a facility tour.

It was alleged the facility did not follow proper COVID-19 infection control protocols. An interview with former Staff1 (S1) revealed they had worked in a unit of the facility where Resident1 (R1) resided and disclosed R1 tested positive for COVID-19. S1 revealed feeling sick the following day and believed to have contracted COVID-19 from R1. The interview with S1 also revealed staff did not put infection control precautions into place. S1 disclosed they had called out sick and was asked to return to take a COVID-19 test. S1 stated the test was administered by the Director of Maintenance (DOM) however, was never given their result. An interview conducted with the DOM revealed they had never administered COVID-19 tests.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 08-AS-20230227134000
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: 07/15/2025
NARRATIVE
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An interview conducted with R1 revealed they felt sick with COVID-19 like symptoms and self administered a COVID-19 test. R1 also disclosed the test had a faint line but they were not sure if they had administered the test correctly. An interview with Staff 2 (S2) and revealed R1 had self administered a rapid COVID-19 test with inconclusive results. S2 also revealed R1 had COPD which can have COVID-19 like symptoms. S2 disclosed R1 was placed in isolation and given a PCR test that yielded negative results.

The Department has investigated the allegation listed above. Based on evidence obtained, including interviews and records reviewed, the above allegation was determined to be unsubstantiated, meaning the evidence did not meet the preponderance of the evidence standard.

An exit interview was conducted with Executive Director, Adrian Guillen and a copy of this report and Licensee Rights (LIC 9058 01/16) will be provided. Signature below confirms receipt of the reports.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
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