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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435200989
Report Date: 02/13/2024
Date Signed: 02/13/2024 04:27:10 PM


Document Has Been Signed on 02/13/2024 04:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 ALTOSFACILITY NUMBER:
435200989
ADMINISTRATOR:MEHRAD MOSHIRIFACILITY TYPE:
740
ADDRESS:1174 LOS ALTOS AVENUETELEPHONE:
(650) 948-7337
CITY:LOS ALTOSSTATE: CAZIP CODE:
94022
CAPACITY:150CENSUS: 113DATE:
02/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rod MoshiriTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Rod Moshiri, Administrator.

The purpose of the visit was to address an incident that occurred on 01/07/2023 and was self-reported by the facility via SOC341 Suspected Adult/Elder Abuse Form and LIC624 Unusual Incident/Injury Report (UIR) on 01/09/2023. The incident involved an unauthorized male who entered the facility through a side exit door that had been propped open. The unauthorized male proceeded to enter the facility, entered into resident R1’s living unit, and sexually assaulted R1. The incident was investigated by the Department beginning on 01/11/2023 and the Department conducted interviews with staff, residents, and witnesses and reviewed records.

During interviews, staff stated the side exit doors are used and held propped open to allow easy access to and from the facility. The side exit doors are supposed to be used only if there is a fire. All residents are to use the main entrance and not the side exit doors. Side exits are to be shut, latched, and always locked. Interviews with multiple residents revealed that residents at BridgePoint at Los Altos would open the exit doors to keep the exit doors from locking.

The local Police Department (PD) investigated and created an investigative report. R1 disclosed that the unauthorized male got on top of R1, “humped” R1, and used his fingers to rub R1’s genitalia. Resident R2 told PD officers that R2 observed the unauthorized male and told staff of the unauthorized male’s presence, but staff ignored R2 multiple times.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Administrator Rod Moshiri and a copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/13/2024 04:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2024
Section Cited
CCR
87486.2(a)(4)

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In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
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Licensee agrees to submit a Plan of Correction by POC date to ensure that doors are properly supervised and remain closed, including by hiring 24 hour security to monitor thinge doors during
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 To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: On 01/07/2023, staff did not supervise the side door exit that had been left propped open, allowing an unauthorized male to enter the facility, which posed an immediate safety risk to residents in care.
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construction, upgrading the facility security camera system and changing all the emergency exit doors to the building to ensure proper closure, and conducting staff training on securing exits and enforcing facility visitor policies.

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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: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 02/13/2024 04:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2024
Section Cited
CCR
87468.2(a)(8)

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In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
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Licensee agrees to submit a Plan of Correction to conduct staff training on abuse prevention and response and reviewing resident rights.
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To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by: on 01/07/2023, an unauthorized male entered the facility and sexually abused resident R1, which poses an immediate safety risk to residents in care.
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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: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
LIC809 (FAS) - (06/04)
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