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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202356
Report Date: 03/08/2025
Date Signed: 03/23/2025 11:13:33 AM

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
03/23/2022 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220323104507
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:
09:12 AM
MET WITH:Jolene Sicley TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff did not treat resident with dignity and respect.
Staff made inappropriate comments to resident.
Resident's personal belongings are missing.
Staff opened resident's packages without permission.
Staff did not note a change in resident's condition
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 (FDR), 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 did not treat resident with dignity and respect
It was alleged that staff did not treat resident with dignity and respect. 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.
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 3
Control Number 26-AS-20220323104507
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 made inappropriate comments to resident.

It was alleged that staff made inappropriate comments to residents. 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 deny making inappropriate comments to residents. 5 out 5 staff members deny seeing any staff members speaking inappropriately to residents. An interview with 8 residents were conducted. 8 out 8 deny that staff speak to them inappropriately. Based on the information gathered, it is unclear that the staff made inappropriate comments to residents.

Allegation: Resident's personal belongings are missing.

It was alleged that resident’s personal belongings are missing. During the course of this investigation, this LPA reviewed facility records and conducted resident interviews. Based on interviews conducted, 8 out 8 residents state that they have not missed any important items. 1 out 8 state that they had a shirt go missing once but that something of not large importance. LPA reviewed facility records. Records show that the facility conducts inventory logs when residents are admitted to the facility and will update as needed. Based on the information gathered, it is unclear if the resident’s personal belongings have been missing.

Allegation: Staff opened resident's packages without permission.

It was alleged that staff opened resident’s packages without permission. 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 opening up resident packages. 5 out 5 staff members deny seeing any staff members open the resident’s packaging without permission. An interview with 8 residents were conducted. 8 out 8 deny that staff open their packages and have not seen anything suspicious that would indicate it. Based on the information gathered, it is unclear that the staff opened resident’s packages without permission.

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 3
Control Number 26-AS-20220323104507
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 did not note a change in resident's condition

It was alleged that staff did not note a change of resident’s condition. During the course of this investigation, LPA conducted staff and resident interviews. Based on interviews conducted it was learned that R1 was consistently demanding changes to their care plan however when changed R1 would change their mind and revert back the care plan. Many times, the facility would send the resident out to the hospital to doctors visits to check for any changes however, R1 would refuse care. In addition, LPA reviewed daily notes for R1 which document the attempts to assist R1 with their care. Based on this information gathered, it is unclear if the staff did not note a change of resident’s condition.

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: 3 of 3