435200605-11-7-2024-26-AS-RMAO-DB5NXL-20241118095116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200605
Report Date: 11/07/2024
Date Signed: 11/07/2024 12:19:25 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
10/29/2024 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20241029132630

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:	DATE:	11/07/2024
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Administrator Kurt Gursu		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff are not meeting resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Manuel Monter and Marcela Yanez conducted an unannounced visit to deliver findings regarding the allegation listed above LPA met with Administrator Kurt Gursu

On October 29, 2024, the Department received a complaint alleging Staff are not meeting resident's hygiene needs.

On November 7, 2024, LPA's interviewed residents R1-R10. R1-R9 stated they have not seen any residents who were in an unkept/dirty state. 4 Out of 10 residents (R1, R2, R4, R7) interviewed stated staff assit them with their daily grooming and showers. 5 Out of 10 Residents (R3, R5, R6, R8, R9) interviewed stated they take care of their own hygine needs and don't need assitance. 9 Out 10 residents stated staff will assit them with their grooming and showering if they request. R10 stated he/she did not want to be interviewed and stated he/she was going to a bingo game.
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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: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

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 26-AS-20241029132630

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: 11/07/2024

NARRATIVE

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LPA's interviewed 6 staff (S1-S6). All staff interviewed stated the facility staff assist residents with their daily hygiene needs. All staff interviewed stated they have not seen any resident who is unkempt/dirty or their hygiene needs were not being met. All staff interviewed stated they have not seen any staff ignoring or neglecting residents who need assistance with their hygiene needs.

LPA's interviewed ADM. ADM stated the residents are being assisted with their hygine and its part of their care plan. ADM stated he hasn't noted any residents with odor or residents with their hygiene needs not being met.

During the visit, LPA's toured the facility inside and out, which included but not limited to the memory care and assisted living sections of the facility. LPA's did not observe any residents that were unhygienic / dirty or unkempt.

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.

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

LIC9099 (FAS) - (06/04)

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