435200930-3-24-2025-26-AS-MPAA-DJZMPJ-20250728094711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200930
Report Date: 03/24/2025
Date Signed: 03/24/2025 04:02:44 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
02/22/2024 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20240222084337

FACILITY NAME:	VI AT PALO ALTO		FACILITY NUMBER:	435200930
ADMINISTRATOR:	STEVE A. BRUDNICK		FACILITY TYPE:	741
ADDRESS:	620 SAND HILL ROAD		TELEPHONE:	(650) 853-5000
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94304
CAPACITY:	876	CENSUS: 536	DATE:	03/24/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Valerie Alves		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff do not provide residents with activities while in care
Staff do not ensure that the facility remains free of odors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Valerie Alves. On 02/22/2024, the department received a complaint with the above allegations. On 02/28/2024, LPA Marrufo conducted an initial complaint investigation visit. Additional visits were conducted on 08/02/2024 and 12/18/2024.

LPA Marrufo obtained a copy of the Care Center Newsletter, dated Winter 2024. The newsletter states: “High Tea Tasting: The Memory Support residents gather together to enjoy tea, music, and conversation”, “Christmas Card Activities: Memory Support also enjoyed writing Christmas cards for their families” and “Gratitude Jar Activity: Memory Support residents fill the gratitude jar with a list of things for which they are really grateful.” The newsletter has 10 photographs depicting residents in the Memory Care unit participating in activities. The photographs depict at least seven different residents participating in activities.

See LIC9099-C pages for more information. Page 1 of 4.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

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 4

Control Number 26-AS-20240222084337

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: VI AT PALO ALTO	FACILITY NUMBER: 435200930
	VISIT DATE: 03/24/2025

NARRATIVE

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LPA Marrufo obtained copies of invoices for items ordered by the facility and delivered to the facility Lifestyle Department. The invoices are dated from July 11, 2023 to December 6, 2023. The invoices include items such as Christmas ornament craft kits, Dementia Activities for Seniors with Memory Loss, large print coloring books, painting canvases, watercolor sets, and playing cards.

LPA Marrufo obtained a copy of the Memory Support 1:1 Room Visits Log dated 02/23-25/2024. The log records that on 02/23/2024, staff entered the rooms of three residents and offered them exercise sessions, but two out of the three residents declined. Staff provided newspapers and books to one of the residents who declined. On 02/24/2024, staff entered the rooms of three residents. Two of the residents participated in an exercise program and one of the residents discussed engineering and science with staff. On 02/25/2024, staff entered two resident rooms. One resident participated in an exercise session and the other resident declined the invitation to the exercise session and walked with his/her private duty aid instead.

During visit on 02/28/2024, LPA Marrufo toured the facility, including the office where supplies for activities were stored. LPA observed a rolling bookshelf, a shelf with DVD movies, dumbbells, and art supplies.

During interview on 02/28/2024, staff S1, facility Lifestyle Director, stated that staff have been bringing memory care residents to activities. S1 stated that staff provided activities such as coloring books, watercolors, and craft projects to the memory care residents.

During interview on 02/28/2024, S2, facility Assisted Living Lifestyle Coordinator, stated that memory care residents have been attending activities with assisted living residents while the facility searches for a new Memory Care Activities Coordinator. S2 stated that staff will conduct room visits with memory care residents who are unable to leave their rooms and conduct one-on-one activities with them.

During visit on 02/28/2024, LPA Marrufo interviewed 5 other staff. 4 out of the 5 interviewed staff stated that there have been activities at the facility since the prior Memory Care Activities Director left. The same 4 out of 5 interviewed staff stated that staff bring books and craft materials to residents in their rooms if the residents are not able to attend exercise activities. 1 out of 5 interviewed staff stated that there have not been activities at the facility. Page 2 of 4.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20240222084337

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: VI AT PALO ALTO	FACILITY NUMBER: 435200930
	VISIT DATE: 03/24/2025

NARRATIVE

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On 03/24/2025, LPA Marrufo attempted to contact 5 resident family members by telephone. 2 out of the 5 resident family members answered LPA Marrufo’s telephone call. Family Member FM1 stated that there are activities offered to residents at the facility. FM2 stated to have observed television programs offered to residents in the memory care unit.

During visit on 02/28/2024, LPA Marrufo toured the facility, including the office where ADM’s dog stayed. LPA Marrufo observed the office to have a cage for the dog and that the dog was leashed. LPA toured did not observe any dog urine odor or foul odors.

During interview on 02/28/2024, ADM stated that ADM bathes the dog at home as often as dogs are supposed to be bathed. ADM stated the dog is taken outside to relieve itself on the planter boxes outside the facility. ADM stated the dog has never had an accident inside the facility.

During interviews on 02/28/2025, 7 out of 7 interviewed staff stated to have not observed any dog odors at the facility.

During interviews on 12/18/2024, LPA Marrufo interviewed two housekeeping staff. Both staff stated to have never observed any dog odors at the facility.

LPA Marrufo obtained copies of facility cleaning logs from 12/12/2023 to 02/22/2024. The cleaning logs indicate the administration offices and corridors are cleaned daily.

During interviews on 03/24/2025, FM1 and FM2 stated to have never observed any dog odors at the facility.

During interview on 03/24/2025, LPA Marrufo interviewed a concierge staff who has worked at the front desk in the Assisted Living portion of the facility. The concierge staff stated to have never observed any dog odors at the facility.

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SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20240222084337

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: VI AT PALO ALTO	FACILITY NUMBER: 435200930
	VISIT DATE: 03/24/2025

NARRATIVE

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Based on information from interviews conducted with staff and resident family members, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22

This report was reviewed with ADM Valerie Alves and a copy of this report was provided.

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END REPORT

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4