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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430708817
Report Date: 01/22/2024
Date Signed: 01/22/2024 04:06:05 PM

Substantiated


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
04/04/2023 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20230404163203
FACILITY NAME:TERRACES OF LOS GATOS, THEFACILITY NUMBER:
430708817
ADMINISTRATOR:BURGOYNE, BRADLEYFACILITY TYPE:
741
ADDRESS:800 BLOSSOM HILL ROADTELEPHONE:
(408) 356-1006
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:458CENSUS: 285DATE:
01/22/2024
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Greg BearceTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Residents are being financially abused.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced visit to conclude the complaint investigation. LPA Monter met with ADM and stated the purpose of the visit.

On 4/4/2023, the Department received a complaint with the above allegation. On 4/11/2023 the Department conducted the initial investigation of financial abuse by private caregiver PC1 and PC2 who misappropriated resident R1’s finances and applies undue influence toward R1 for financial gain.

On 4/04/2023, the Department conducted an initial investigation visit to the facility that a resident is being financially abused. On 4/11/23 the Department received additional information and the case was reopened.

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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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 3
Control Number 26-AS-20230404163203
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: 01/22/2024
NARRATIVE
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Continuation from page 1

Based on investigation, document reviews, and interviews, private caregiver 1(PC1) & private caregiver 2 (PC2) engaged in conduct that is inimical to the health and morals, welfare or safety of either an individual in or receiving services. PC1 & PC 2 engaged in acts of financial malfeasance concerning the operation of a facility, including, but not limited to, improper use or embezzlement of client moneys and property or fraudulent appropriation for personal gain of facility moneys and property, or willful or negligent failure to provide services for the care of clients.

Based on documentation, interviews and observation, the preponderance of evidence standard has been met therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D.

This report was reviewed with Administrator and a copy of the report was provided. Appeal Rights was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 26-AS-20230404163203
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2024
Section Cited
HSC
1569.58(a)
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1569.58 Persons prohibited from being a licensee, ... or holding certain positions ... appeal; petition for reinstatement (a)The department may prohibit any person ... person who is not a client and who has done any of the following This requirement was not met as evidenced by;
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ADM stated those two private care givers would no longer be let back in the facility. ADM stated he will send a written plan of action on overseeing private care givers hired by residents, including those in independent living. ADM to submit POC to LPA by 01/24/24.
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Based on interviews conducted, and evidenced reviewed, private caregiver PC1 and PC2 misappropriated resident R1’s finances and applied undue influence toward R1 for financial gain. This poses an immediate threat to residents health, safety and personal rights.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC9099 (FAS) - (06/04)
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