374604855-8-1-2025-08-AS-AROS-DK5VU2-20250801164400

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604855
Report Date: 08/01/2025
Date Signed: 08/01/2025 04:45:49 PM

Document Has Been Signed on 08/01/2025 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	MONTERA, THE		FACILITY NUMBER:	374604855
ADMINISTRATOR/ DIRECTOR:	KABADI, SANJAY		FACILITY TYPE:	740
ADDRESS:	5740 LAKE MURRAY BLVD		TELEPHONE:	(619) 464-6801
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY: 225		CENSUS: 185	DATE:	08/01/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Executive Director Cathy Allen		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, LPAs Amy Rodgers and Janet Ngallo made an announced site visit to the facility for a Pre-licensing and Component III visit. LPAs met with the Executive Director Cathy Allen. The fire inspection for the facility was completed on January, 27, 2025. The facility was approved for 225 non-ambulatory residents of which 20 residents can be bedridden limited to the first floor units. Facility has a sprinkler system, carbon monoxide detectors, and smoke detectors. LPA's discussed Hospice and personal rights with management staff. . LPAs toured the facility campus and conducted a review of apartments on campus, common areas and grounds. There are 3 separate building on campus, with Building B and C housing residents. Each unit has a private bathroom. The bathrooms each have either a tub cut or walk-in showers. There is a large recreational area and dinning area with additional areas on campus for dinning and recreation as well as smaller meeting rooms throughout the campus. LPA checked the facility kitchen which was clean with all working industrial appliances for residents. The kitchen was fully stocked with the supplies to provide the required food service. The water temperature was checked and was within regulation. There was over a seven day supply of perishable and 2 non-perishable foods. Facility has a variety of recreation areas including a fitness area, activity rooms, computer lounge, library, theater and a beauty salon. There is also a pool with five foot fencing and a locked self-latching gate. (continued on LIC9099C)

NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Amy Rodgers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MONTERA, THE	FACILITY NUMBER: 374604855
	VISIT DATE: 08/01/2025

NARRATIVE

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(Continued from LIC9099)

Facility has plenty of outside activity space with walking paths. Staff records and part of resident records are kept locked in the business office area. There are two locked medication rooms with two LVN's on staff. The resident medical records are kept in the medication area along with most of the medications. Facility has first aid supplies and book with the required first aid items. LPA reviewed the applicant's Infection Control Plan and Emergency Disaster Plan.

LPA's observed a memory care neighborhood housed on the first floor in building B. There are four delayed egress entrance/exit doors, two leading to a secured outside patio. The patio is fenced and there are 3 secured perimeter exit gates which can only be opened by a key fob.

LPA conducted Component III with the applicant. The topics discussed were continuing operation
requirements, record keeping/reporting, and physical plant compliance.

Pre-licensing is complete, and this facility has no deficiencies.

It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with the Executive Director Cathy Allen, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

NAME OF LICENSING PROGRAM MANAGER: Simon Jacob
NAME OF LICENSING PROGRAM ANALYST: Amy Rodgers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

LIC809 (FAS) - (06/04)

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