430708817-10-4-2024-26-AS-RMAO-DA8TYB-20241020150828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430708817
Report Date: 10/04/2024
Date Signed: 10/04/2024 01:55:14 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/26/2024 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20240926164112

FACILITY NAME:	TERRACES OF LOS GATOS, THE		FACILITY NUMBER:	430708817
ADMINISTRATOR:	GREGORY BEARCE		FACILITY TYPE:	741
ADDRESS:	800 BLOSSOM HILL ROAD		TELEPHONE:	(408) 356-1006
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY:	458	CENSUS:	DATE:	10/04/2024
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Residential Living Director Sandy Mirasol		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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A resident was inappropriately touched by a staff

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Manuel Monter and Marcella Tarin conducted an unannounced complaint investigation visit and met with Residential Living Director Sandy Mirasol.

On September 26, 2024, the Department received a complaint alleging a resident was inappropriately touched by a staff. It has been alleged that R1 was inappropriately touched on September 19, 2024.

On September 28, 2024, LPA obtained and reviewed Independent, Assisted and Memory Care Unit’s copy of resident and staff rosters including names of residents who were recently, temporarily, and permanently admitted at their Skilled Nursing Facility (SNF) which is under the CA Department of Health.

Page 1 Out of 2.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

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 26-AS-20240926164112

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: TERRACES OF LOS GATOS, THE	FACILITY NUMBER: 430708817
	VISIT DATE: 10/04/2024

NARRATIVE

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Staff S1 provided a detailed information of each 3 residents who were from their Assisted, Independent and Memory Care. 1 Out 3 residents (referred as R1) were transferred to Skilled Nursing Facility on September 2024, because of a fall while others need higher level of care and/or rehabilitation. S1 stated that R1 has never been back to his/her independent residence since he/she was admitted to SNF. S1 stated R1 will be returning to his/her independent living unit on September 28, 2024.

S1 is the director of independent living unit wherein S1 was informed about the alleged sexual abuse by R1 that happened on September 19, 2024, and the investigation conducted by law enforcement agency at SNF. S1 stated that the alleged sexual abuse did not occur within the premises of the Assisted, Independent and Memory Units. S1 stated that they don't have staff working at SNF.

Based on record review and interviews, R1 has neurocognitive disorder.

On October 4, 2024, LPA Monter and Tarin interviewed Skilled Nursing Health Services Administrator (HSA). HSA stated resident R1 was located at the SNF from September 10 - September 28, 2024. HSA stated he/she is aware of the allegations that R1 has made during his/her stay at the SNF and reported it. HSA stated local law enforcement did come to the SNF and took a report.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

No deficiencies cited, an exit interview conducted with Residential Living Director Sandy Mirasol and a copy of the report was provided.

Page 2 Out of 2. END OF REPORT.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

LIC9099 (FAS) - (06/04)

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