435202509-2-2-2023-26-AS-KHOS-CP2LBE-20230214073635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202509
Report Date: 02/02/2023
Date Signed: 02/02/2023 12:00:57 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
12/16/2020 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20201216153905

FACILITY NAME:	VILA MONTE		FACILITY NUMBER:	435202509
ADMINISTRATOR:	DONALD WINDHAM		FACILITY TYPE:	740
ADDRESS:	17090 PEAK AVENUE		TELEPHONE:	(408) 500-2693
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	28	CENSUS:	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	10:58 AM
MET WITH:	Nicholas Inneh		TIME COMPLETED:	12:03 PM

ALLEGATION(S):

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Resident is being financially abused

INVESTIGATION FINDINGS:

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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced visit to deliver the complaint investigation finding regarding the above allegation. LPA met with facility Administrator Nicholas Inneh (Admin).

On 09/20/2021, the depratment conducted an audit investigaiton of the facility, during the investigation, a cash count was performed to ensure that the amount of money for individual residents matched what was stipulated on the client ledger (LIC 405). After concluding the cash count, it was determined that 11 residents had, on average, $1-$10 more in their individual cash stocks than what was recorded officially on the LIC 405. 6 residents had no variance, and one resident had $4 less than what was recorded.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-20201216153905

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: VILA MONTE	FACILITY NUMBER: 435202509
	VISIT DATE: 02/02/2023

NARRATIVE

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Upon discovery of cash discrepancy, former Administrator Donald Windham (FA), went to a safe, collected four dollars, and resupplied resident's cash resources. FA indicated that the facility always has cash on hand just in case there is a discrepancy. FA stated that he was unsure why there were light discrepancies in the cash reserves of 12 residents. The audit report indicates that, despite the difference in ledger amount listed and amount of cash counted, the cash count ultimately did not result in any evidence of financial abuse.

During the investigation, the department attempted to interview suspected victim of financial abuse in multiple instances. In every attempted interview, suspected victim stated that they did not want to speak on the matter and requested that the investigation be shut down. Audit report indicates that there were no other residents identified as potential victims of financial abuse during the course of the investigation. Audit report concludes that there is no evidence to substantiate the claims of financial abuse.

This Department has investigated the above allegation. Based on records review, interviews, and observation, the Department has determined that the allegation was UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview conducted. This report was reviewed with Administrator Nicholas Inneh and a copy was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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