435200605-8-7-2024-26-AS-RMAO-D8AH6X-20240819055553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200605
Report Date: 08/07/2024
Date Signed: 08/07/2024 03:38:27 PM

Unsubstantiated

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
03/16/2023 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20230316164952

FACILITY NAME:	ATRIA WILLOW GLEN		FACILITY NUMBER:	435200605
ADMINISTRATOR:	GURSU, UGUR (KURT)		FACILITY TYPE:	740
ADDRESS:	1660 GATON DR		TELEPHONE:	(408) 266-1660
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	63	CENSUS: 48	DATE:	08/07/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Kurt Gursu		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff inappropriately touched resident in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Administrator Kurt Gursu.

On March 16, 2023, the Department received a complaint alleging Staff inappropriately touched resident in care.

On March 16, 2023 Local Law Enforcement interviewed R1 regarding the allegations of staff inappropriately touching him/her. R1 stated when he/she first arrived at the facility, he/she was advised he/she needed a bath by a staff member. R1 stated the staff member used soap and was scrubbing all over R1’s body, including R1’s genitals and chest. R1 stated he/she didn’t know if the staff member did it for their gratification and stated nothing else happened. R1 stated he/she would not be able to recognize the staff member.
Page 1 Out of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 712-2018
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

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-20230316164952

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: ATRIA WILLOW GLEN	FACILITY NUMBER: 435200605
	VISIT DATE: 08/07/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On August 7, 2024, LPA Monter interviewed staff S1-S6. 6 Out of 6 staff interviewed denied the allegation that staff were touching residents inappropriately, when given showers.

LPA Monter interviewed residents R2-R6. 4 Out of 6 residents (R2-R4) interviewed stated staff do not touch residents in an inappropriate manner when given showers. Resident R5 was unable to respond to LPA's questions due to neurocognitive disorder. Resident R6 stated he/she declined to be interviewed.

A review of R1’s physicians report dated, December 13, 2022, states R1 has a neurocognitive disorder, with intermittent confusion.

A review of R1’s Needs and Services Plan (ANS), dated January 6, 2023, states R1 R1 requires limited assistance 2 times per week. (Limited being defined by the Needs and services plan as; “requires extensive assistance for all bathing/showering needs.”). The ANS also states R1 has a neurocognitive disorder.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

This report was reviewed with Administrator Kurt Gursu and a copy of the report was provided.

Page 2 Out of 2.

END OF REPORT.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 712-2018
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2