435202350-2-5-2025-26-AS-KHOS-DENNDV-20250311102259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202350
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:39:03 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
03/13/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20230313164543

FACILITY NAME:	BELMONT VILLAGE SAN JOSE		FACILITY NUMBER:	435202350
ADMINISTRATOR:	NATALIE BARMAN		FACILITY TYPE:	740
ADDRESS:	500 S WINCHESTER BLVD		TELEPHONE:	(408) 984-4767
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	150	CENSUS: 117	DATE:	02/05/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Executive director - Rachel Brown		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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- Facility is not kept clean
- Dishes to serve residents food are dirty

INVESTIGATION FINDINGS:

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On 02/05/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver the findings regarding the received allegations. LPA met with executive director Rachel Brown and explained the purpose of today's visit.

During the course of the investigation interviews were conducted, observations were made, and documents were received. Based on the information provided there are dishwashers present at the facility and substantial food supply observed. Per interviews any dishes that do not meet standards are usually replaced with new or cleaner dishes. Some cutlery and mugs were observed to have staining but this was not apparent on all mugs, cups, dishes, and cutlery. These allegations are unsubstantiated based on the totality of observations made and investigation conducted.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. Report is reviewed with Rachel Brown and a copy is provided on this day.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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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