435202665-9-5-2024-26-AS-KHOS-D92SBK-20240912134405

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202665
Report Date: 09/05/2024
Date Signed: 09/05/2024 11:16:09 AM

Unfounded

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
02/03/2022 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20220203140916

FACILITY NAME:	LOMA CLARA SENIOR LIVING		FACILITY NUMBER:	435202665
ADMINISTRATOR:	JENNIFER BRUHN		FACILITY TYPE:	740
ADDRESS:	16515 BUTTERFIELD BLVD		TELEPHONE:	(669) 258-3500
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	89	CENSUS: 81	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Eugenia Smith		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Resident not allowed to have phone calls.
Resident not allowed to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Christine Dolores and Marcella Tarin arrived unannounced to deliver the findings of the above allegations. LPAs met with Executive Director, Eugenia Smith.

On 02/03/2022, the Department received the complaint. On 02/10/022, the initial complaint investigation was conducted.

The following documents were obtained to include R1’s admission agreement, physician’s report, health care directive, POA documents, Trustee document, and correspondence.

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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 2

Control Number 26-AS-20220203140916

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: LOMA CLARA SENIOR LIVING	FACILITY NUMBER: 435202665
	VISIT DATE: 09/05/2024

NARRATIVE

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It was alleged that the facility staff did not allow resident (R1) to have phone calls and visitors.

On 02/10/2022, LPA Donovan interviewed 3 staff members. Based on staff interview, R1 has a cell phone and the facility has a land line/ house phone that receives incoming calls as well. Staff denied programming R1’s phone to block calls. It was stated that visits are based on the resident’s choice and are allowed as long as they meet the screening process.

3 out of 3 staff denied denying visitations and denied preventing R1 from receiving phone calls. It was stated that R1 preferred not to be alone with a certain visitor. It was stated that when this specific visitor visits R1, a staff member will be present with the consent of R1.

On 02/10/2022, LPA Donovan interviewed R1. Based on resident interview, R1 does not want to see a particular visitor. R1 states he/she has a cell phone.

The review of records shows that R1 did not want to see a particular visitor and wished for the facility staff to intervene if this visitor attempts to take R1 out of the community.

The Department has investigated the above allegations. Based on interview and record review the above allegations are unfounded, meaning the allegations are false, could not have happened, and/or is without a reasonable basis.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Eugenia Smith and a copy of the report was provided.

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SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

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