435200989-3-19-2025-26-AS-KHOS-DH9KJU-20250602075719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200989
Report Date: 03/19/2025
Date Signed: 03/19/2025 05:32:48 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
01/04/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20230104161651

FACILITY NAME:	BRIDGEPOINT AT LOS ALTOS		FACILITY NUMBER:	435200989
ADMINISTRATOR:	MARIA QUINTERO		FACILITY TYPE:	740
ADDRESS:	1174 LOS ALTOS AVENUE		TELEPHONE:	(650) 948-7337
CITY:	LOS ALTOS	STATE: CA	ZIP CODE:	94022
CAPACITY:	150	CENSUS: 128	DATE:	03/19/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Rod Moshiri		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Residents not being provided their medications as prescribed.
Staff not providing adequate food service.
Staff not providing services to residents in care.
Residents are not provided activities.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator (ADM) Rod Moshiri. On 01/04/2023, the Department received a complaint with the above allegations. On 01/12/2023, LPA Marrufo conducted an initial complaint investigation visit. Additional visits were conducted on 10/10/2024 and 01/09/2025.

LPA Marrufo obtained copies of the Medication Administration Records (MAR) for residents R1-R4 from the months November 2022 to January 2023. R1’s MAR indicates that R1 was provided medications as prescribed. R2’s MAR indicates that R2 was provided medications as prescribed but had empty boxes on 10:30 AM and 12:00 PM on 11/27/2022 and 10:30 AM on 12/29/2022. R3’s MAR indicates that R3 was provided medications as prescribed but had empty boxes on 12:00 PM on 11/27/2022 and 6:00 AM 12/31/2022. R4’s MAR indicates R4 was provided medications as prescribed but had empty boxes on 1:00 PM on 11/10/2022. See LIC9099-C for more information. Page 1 of 5.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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 5

Control Number 26-AS-20230104161651

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: BRIDGEPOINT AT LOS ALTOS	FACILITY NUMBER: 435200989
	VISIT DATE: 03/19/2025

NARRATIVE

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During interview on 03/19/2025, staff S3, Assisted Living Director, stated that the boxes in the MARs may have been due to the resident being out of the facility without the resident’s absence being recorded.

During visit on 01/09/2025, LPA Marrufo interviewed 10 residents. 7 out of 10 interviewed residents stated that staff provide them their medications as prescribed. 3 out of 10 interviewed residents stated that they do not require assistance from staff with being provided medications as prescribed.

LPA Marrufo obtained a copy of the Dinning Services Food Servers Schedule, which indicates that there 10 food servers scheduled per day. LPA Marrufo obtained a copy of the Kitchen Schedule, which indicates that there are four cooks scheduled each day as well as an AM and a PM dish runner. LPA Marrufo obtained a copy of the Dinning Menu, which indicates breakfast, lunch, and dinner are served each day. Lunch and dinner include soup, salad, three entrees, and dessert.

During interview on 01/12/2023, ADM Moshiri stated that residents are allowed to have second servings and residents are delivered meals to their living units when residents are under quarantine or isolation. During visit on 03/19/2025, the communal dinning services were suspended due to cases of gastrointestinal symptoms at the facility.

During interviews on 01/09/2025, 9 out of 10 interviewed residents stated that the thought the food service at the facility was good. 1 out of 10 residents stated the food service at the facility is sometimes good and sometimes not good. 9 out of 10 interviewed residents stated that the food is delivered on time. 1 out of 10 interviewed residents stated that the food is not always delivered on time and is sometimes delivered cold. 9 out of 10 interviewed residents stated the food quality is good. 1 out of 10 interviewed residents stated the food quality needs improvement.

On 03/19/2025, LPA Marrufo interviewed staff S1, who is a cook at the facility, and staff S2, who is the Culinary Service Director. S1 stated that S1 ensures that residents are provided with adequate food service by washing and preparing foods and preparing them at temperature as well as ensuring food is not overcooked or undercooked.

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SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 26-AS-20230104161651

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: BRIDGEPOINT AT LOS ALTOS	FACILITY NUMBER: 435200989
	VISIT DATE: 03/19/2025

NARRATIVE

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S2 stated that S2 ensures that residents are provided with adequate food service by hiring qualified staff and acquiring the best ingredients.

LPA Marrufo obtained copies of R1-R4s Care Plans. R1, R3, and R4’s Care Plans do not require monthly checking and recording of vitals and weight. R2’s Care Plan requires monthly checking and recording of vitals and weight.

LPA Marrufo obtained a copy of R1 and R2’s Care Tracking Logs from 11/01/2022 to 01/31/2023. R1’s Care Tracking Log has 78 entries recording staff assisting R1 with toileting and 19 entries recording staff assisting R1 with dressing. R2’s Care Tracking Log has 33 entries recording staff assisting with toileting, 8 entries recording staff assisting with dressing, and six entries recording staff assisting with bathing. R2’s Care Tracking Log has entries on 11/10/2022, 12/15/2022, and 1/12/2023 in which staff checked R2’s vitals. The entries do not include the results of R2’s vitals. The entries on 11/10/2022 and 1/12/2023 indicate that R2 refused to be weighed.

LPA obtained a copy of R2’s Vitals Record, which does not have any vitals data entered from 06/09/2022 to 02/09/2023. During interview on 03/19/2025, staff S3, the Assisted Living Director, stated that it is possible R2’s vitals data were recorded on apreviously used electronic MARs system, which the facility discontinued to use since July 2024 and can no longer access.

On 01/09/2025, LPA Marrufo interviewed 10 residents. 9 out of 10 residents stated the staff provide them with all services. 1 out of 10 interviewed residents stated that he/she is independent and does not need staff to provide him/her with services.

7 out of 10 interviewed residents stated staff check their vitals once a month. 1 out of 10 interviewed residents stated staff check his/her vitals once a month, but sometimes the staff go longer than a month before checking his/her vitals. 2 out of 10 interviewed residents stated that they do not need the staff to check their vitals.

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SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 26-AS-20230104161651

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: BRIDGEPOINT AT LOS ALTOS	FACILITY NUMBER: 435200989
	VISIT DATE: 03/19/2025

NARRATIVE

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6 out of 10 interviewed residents stated that the staff check their weight once a month. 1 out of 10 interviewed residents stated that staff check his/her weight, but staff have not weighed him/her during the holiday months of November and December. 1 out of 10 residents stated he/she refuses to be weighed. 2 out of 10 residents stated they do not need the staff to weigh them.

On 03/19/2025, LPA Marrufo interviewed 4 staff care givers. 4 out of 4 interviewed care givers stated that they change resident diapers, shower the residents, assist them with changing clothing, and escort the residents to activities. 3 out of the 4 interviewed care givers stated that they do not remember R1 or R2. 1 out of the 4 care givers stated to have remembered both R1 and R2. The care giver stated to have assisted R1 and R2 with changing their diapers. The care giver stated to have observed R2 to be in soaked diapers from the night before. The care giver stated to believe that the night shift staff may not have checked R2’s diaper to check if it was soaked. LPA Marrufo asked the care giver how he/she knew whether R2 had a soaked diaper throughout the night or instead had urinated shortly before the care giver’s shift. The care giver stated to have not known for sure which was the case.

LPA Marrufo obtained the Activities Calendar from December 25, 2022 to January 31st, 2023. The Activities Calendar indicates there were multiple activities offered each day.

On 01/12/2023, LPA Marrufo interviewed staff S4, Wellness Director. S4 stated that activities are offered every day, including daily exercise activities and weekly activities such as bingo, art, and karaoke.

During interview on 01/09/2025, 10 out of 10 interviewed residents stated that activities are offered at the facility.

During interview on 03/19/2025, 4 out of 4 interviewed staff stated that they escort resident to activities and encourage residents to participate in activities.

During visits on 01/09/2025 and 03/19/2025, LPA Marrufo toured the Activity Room and observed sign-ups for activities as well as activity materials.

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SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 26-AS-20230104161651

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: BRIDGEPOINT AT LOS ALTOS	FACILITY NUMBER: 435200989
	VISIT DATE: 03/19/2025

NARRATIVE

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Based on information from interviews conducted with staff and residents, 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 Administrator Rod Moshiri and a copy of this report was provided.

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END REPORT

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC9099 (FAS) - (06/04)

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