Monteverde Manor

Type of visit: Case Management - Deficiencies

On April 29, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit. LPA met with caregiver, Renato Pera and LPA explained the purpose of today's visit. During the annual visit on 4/22/2026, LPA requested for a copy of the current administrator certification to be submitted to CCL by 4/24/2026. On 4/28/2026, LPA called the administrator and requested for a copy of the current administrator certificate and the administrator stated that he did not have it as he is working on the renewal process. Based on observation interview and record review, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with caregiver. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Apr 30, 2026

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator...this requirement is not met as evidenced by the administrator's certificate has expired which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2026

Plan of correction: The administrator/ licensee will develop a plan to ensure that the administrator completes the re-certification process in a timely fashion. In addition, the licensee will appoint an acting administrator for the facility while the administrator is working on the renewal process. The administrator will provide a copy of the plan of correction to CCL by 4/30/2026. The administrator will provide documents to CCL by 5/8/2026 to proof that the renewal process is completed.

Type of visit: POC

On April 29, 2026, Licensing Program Analyst (LPA) Murial Han conducted a plan of correction visit for the annual inspection that was conducted on April 22, 2026. LPA met with caregiver, Renato Pera and Ronil Maning and explained the purpose of today's visit. During today's visit, LPA toured the common areas, bath/shower room, dining room, living room, and resident's rooms. LPA checked hot water temperature in the bath/shower rooms was measured at 112 - 114 degrees F; LPA observed the faucets in the kitchen and the bathroom by room 3 were replaced; LPA observed the non-slip mat was placed in the bath/shower room by room 3; LPA reviewed the pre-admission appraisals and reappraisals. The following deficiencies , which were cited on 4/22/2026 are corrected: - 87303(e)(2) Maintenance and Operation - 87457(c) Pre-Admission Appraisal - 87303(a) Maintenance and Operation -87303(e)(5) Maintenance and Operation - 87463(a) Reappraisals The administrator will provide a copy of the completed preplacement appraisals for R1, R2 and R3 and reappraisals for R4 and R5 by 4/30/2026. This report is reviewed and discussed with the caregiver. A copy is provided.the state’s words, verbatim · CDSS document, Apr 29, 2026

Type of visit: Required - 1 Year

On April 22, 2026 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, Renato Pera and explained the purpose of the visit. The administrator arrived and assisted with the rest of the inspection. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, garage, side yard and backyard. The facility has 5 resident rooms (one shared room) and 1 staff room. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Lamp and lights were present in all rooms and hallways. Toilet, hand washing and bathing areas were observed clean and in operating condition. Bathroom/Shower rooms were observed equipped with non-skid mats and grab bars except for the bathroom/shower room in room 4 did not have a non-skid mat. Central storage for medications was locked. LPA observed the faucets in the kitchen and bathroom in room number 4 were disrepair/ loose. Hot water temperature in the kitchen and bathroom were measured at 125- 138 degrees Fahrenheit. Fire extinguisher checked and last inspected on October 10, 2025. Sharps, chemical and toxins were observed to be locked and inaccessible to residents in care. Emergency drill records were reviewed to be adequate. A review of (5) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. The following documents were requested submitted to CCL by 4/24/2026: - liability insurance; control property, and administrator certification. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Required - 1 Year

On April 16, 2025 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, Renato Pera and explained the purpose of the visit. The administrator arrived and assisted with the rest of the inspection. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, garage, side yard and backyard. The facility has 5 resident rooms (one shared room) and 1 staff room. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Lamp and lights were present in all rooms and hallways. Toilet, hand washing and bathing areas were observed clean and in operating condition. Showers were observed equipped with non-skid mats and grab bars. Central storage for medications was locked. Hot water temperature in the kitchen and bathroom were measured at 130-160 degrees Fahrenheit. Fire extinguisher checked and last inspected on October 4, 2024. Sharps, chemical and toxins were observed to be locked and inaccessible to residents in care. Emergency drill records were inadequate. A review of (4) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. The following documents were requested submitted to CCL by 4/18/2025: - liability insurance; control property, and administrator certification. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 16, 2025

Allegation investigated: Staff neglected to provide medical attention to resident resulting in stage 4 injury.

On 4/9/2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the complaint investigation findings. LPA met with the administrator and explained the purpose of today's visit. Regarding to the allegation of- staff neglected to provide medical attention to resident resulting in stage 4 injury, there is no additional information forthcoming from the reporting party. However, during the initial reporting, the reporting party stated that when resident #1( R1) was admitted to the facility with a stage 2 pressure ulcer and when R1 was transferred to the hospital due to a change in health condition, the pressure ulcer got worse to a stage 4. The reporting party stated that R1 feels neglected by the facility and did not receive the proper care. Unfounded As part of the investigation, LPA interviewed R1, the administrator, staff member and review documentation, LPA interviewed R1 who stated that facility staff was providing good care and R1 was comfortable at the facility. The administrator denied the allegation and stated that R1 was admitted with a pressure ulcer and home health nurse was providing treatment to the wound. However, R1 was not compliant with being turned and repositioned resulting wound got worse. The administrator stated that this observation was noted and documented by the home health nurse and facility staff. LPA interviewed staff #1(S1) who stated that they turned and repositioned R1 every 2 hours but sometimes R1 did not want to comply, but they continued to encourage. S1 stated that R1’s wound was being treated by the home health and hospice nurses. Based on documentation provided by the facility, it revealed that R1 was refusing to be turned by the facility staff and refused pressure injury prevention measures that were recommended by the home health nurse. After the investigation, this allegation is deemed to be unfounded as R1 stated that he/she was comfortable and facility staff was providing good care. In addition, facility documentation indicated that R1 was refusing pressure ulcer prevention measures and safety precautions. The Department has investigated the complaint allegations of possible physical plant violations. It was determined the allegations are unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis and therefore dismissed.the state’s words, verbatim · CDSS document, Apr 9, 2025 · control 14-AS-20250206162914

Type of visit: Required - 1 Year

On April 24, 2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, Irma Alcantara and explained the purpose of the visit. The administrator, Dino Martin arrived at the end of the inspection. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, garage, side yard and backyard. The facility has 5 resident rooms (one shared room) and 1 staff room. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Lamp and lights were present in all rooms and hallways. Toilet, hand washing and bathing areas were observed clean and in operating condition. Showers were observed equipped with non-skid mats and grab bars. Central storage for medications was locked. During the tour of the garage, LPA observed it was sectioned off in the middle and one side consisted of washer, dryer and storage cabinets and on the other side, a staff was sleeping in a tent and other furniture around it. Hot water temperature in the kitchen and bathroom were measured at 106- 111 degrees Fahrenheit. Fire extinguisher checked and last inspected on October 26. 2023. Sharps, chemical and toxins were observed to be locked and inaccessible to residents in care. LPA reviewed 3 resident files and 3 staff files. The following documents were requested submitted to CCL by 4/25/24: - liability insurance; and copy of administrator certification. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. . This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 24, 2024

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Apr 25, 2024

87305 Alterations to Existing Building or New Facilities..(a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Based on observation and interview, LPA observed a staff was sleeping in the garage which poses an immediate health and safety risks to residents in carethe state’s words, verbatim · CDSS document, Apr 24, 2024

Plan of correction: The administrator will develop a plan to ensure garage is not a living space for facility staff and submit a copy of the plan to CCL by 4/25/2024.

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Apr 25, 2024

§1569.695 (c)Emergency Plans..c) A facility shall conduct a drill at least quarterly for each shift. This requirement is not met as evidenced by: Based on observation, interview and record review, the facility was not able to provide documents to proof that emergency drills were completed which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Apr 24, 2024