075601300-10-17-2023-15-AS-KHOS-CXBLBS-20231106073712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601300
Report Date: 10/17/2023
Date Signed: 10/17/2023 04:53:53 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2023 and conducted by Evaluator Luisa Fontanilla

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20231011103912

FACILITY NAME:	WESTMONT OF BRENTWOOD		FACILITY NUMBER:	075601300
ADMINISTRATOR:	AGUSTIN SAMANIEGO		FACILITY TYPE:	740
ADDRESS:	450 JOHN MUIR PKWY		TELEPHONE:	(925) 516-8006
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	200	CENSUS: 94	DATE:	10/17/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Michael Talani, Executive Director		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Due to staff negligence, resident is not being changed timely
Due to staff negligence, staff is not assisting resident with hygiene needs

INVESTIGATION FINDINGS:

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On this day at around 10:30 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct investigation on the above allegations and met with Executive Director (ED) Michael Talani and Resident Care Director (RCD) Karren Melad. LPA explained to both the purpose of the visit.

During the visit, LPA interviewed 6 residents, ED, RCD and 2 caregivers on shift. Based on interviews conducted with caregivers, Staff 1 (S1) states S1 assists Resident 2 (R2) with showers and incontinence management. S1 added if R1 refuses to take shower, S1 would assist R2 in getting cleaned and changed. S1 also states that R2's diaper gets changed as often as possible. A review of R2's
Health and Service Evaluation indicates standby assistance for Grooming/Personal Hygiene and Bathing. RCD states all staff are instructed to make sure incontinent residents are changed regularly. RCD added that R2 who is incontinent never had any skin breakdown because staff have been changing R2 regularly.
***continuation on Lic 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa Fontanilla	TELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20231011103912

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: WESTMONT OF BRENTWOOD	FACILITY NUMBER: 075601300
	VISIT DATE: 10/17/2023

NARRATIVE

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S2 states R3's shower is scheduled in the afternoon. However, if S2 observes R3 needs assistance with incontinence management that needed attention right away, S2 would assist R3 with the needed care including assisting R3 with showers.

R3's Health and Service Evaluation indicates standby assistance for bathing once a week and that R3 is independent with Toileting.

While conducting interview with R2, LPA observed R3 taking a shower with S2 assisting.

During the visit with R2 and R3, LPA observed R2's hair and beard needed attention. RCD and ED state that R2 had an appointment with the salon a week prior. When R2 was at the salon, R2 suddenly had an accident and needed to go back to the apartment. By the time R2 was able to go back to the salon, it was closed. ED states since R2 missed the haircut appointment, the salon operator has rescheduled it for R2 in a few days.

During interview with ED, he states that the facility has replaced R2 and R3's bed due to the urine smell which was caused by R2 taking off diapers and sheets. ED states the bed has been replaced twice. ED also informed LPA that R2 and R3 have a doctor's appointment on October 25 for reassessment needed due to decline in cognitive functions. ED added that R2 and R3 were scheduled for reassessment in July 2023 but the family were not able to take R2 and R3 to the appointment.

Based on interviews and records reviews conducted, the above allegations are unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

There is no deficiency issued for today's visit.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa Fontanilla	TELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC9099 (FAS) - (06/04)

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