435202744-4-25-2024-26-AS-RMAO-D4TV7H-20240430161111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202744
Report Date: 04/25/2024
Date Signed: 04/25/2024 05:11:09 PM

Substantiated

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
11/21/2023 and conducted by Evaluator Simranjit Rai

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20231121112922

FACILITY NAME:	WESTMONT OF MILPITAS		FACILITY NUMBER:	435202744
ADMINISTRATOR:	HARMS, STEVEN		FACILITY TYPE:	740
ADDRESS:	80 CEDAR WAY		TELEPHONE:	(408) 770-9575
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	225	CENSUS: 171	DATE:	04/25/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator, Greg Becker		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents in care are not provided transportation services

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator (ADM), Greg Becker and stated the purpose of today’s visit.

On 11/21/2023, the Department received a complaint with the above allegations. On 11/29/2023, the Department conducted an initial investigation at the facility. It was alleged the facility staff suggested residents to cancel their appointments or figuring out their own transportation services.

On 11/29/2023, the Department interviewed 3 staff, including the Administrator (ADM) Steven Harms. ADM stated the facility did not have a licensed driver to drive the facility bus. ADM stated the Activities Director took care of schedule/arranging transportation for the residents.

Continuation on LIC 9099-C, Page 1 of 3.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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 7

Control Number 26-AS-20231121112922

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: WESTMONT OF MILPITAS	FACILITY NUMBER: 435202744
	VISIT DATE: 04/25/2024

NARRATIVE

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Page 2 of 3.

ADM stated the facility has provided a flyer to the residents to share resources, such as taxi and ride share companies for residents to schedule the transportation on their own. ADM stated the facility schedules the transportation appointments electronically to use the facility car/sedan which is available to use at this time. Based on the review of transportation services log, LPA Rai observed 1-2 residents signed up for transportation services every week from October 2023 to November 2023.

2 Out of 3 staff that are in charge of transportation services stated they’ve had to either reschedule medical appointments or request residents to cancel appointment that were already scheduled due to the availability of the driver. 2 staff stated they will drive the residents in the facility’s sedan/car vehicle however if the resident was on a wheelchair and cannot transfer to the sedan/car vehicle, then the resident is not able to go to their scheduled appointment.

On 12/19/2023, the Department interviewed 8 residents. 6 Out of 8 residents did not need transportation services offered at the facility since they were independent, or family was able to provide transportation to and from medical appointments. 2 out of 8 residents stated they needed the facility to provide transportation services and the facility staff did not provide alternative options for when the transportation bus was not available.

On 4/18/2024, the Department interviewed 11 residents. 7 out of 11 residents did not need transportation services offered at the facility since they were independent, or family was able to provide transportation to and from medical appointments. 2 residents declined to make comments about the transportation services provided by the facility. 2 residents stated they needed the facility to provide transportation services and they have not received the transportation services. R3 stated R3 was not able to go to scheduled medical appointment arranged with the Activities Director due to no driver hired by the facility. Resident (R5) stated his/her medical appointments have been schedule with the Activities Director to ensure transportation was available. R5 stated the Activities Director and Activities assistant have requested R5 to cancel the medical appointment the day of the scheduled visit due to driver was not available for transportation. R5 stated due his/her ambulatory status, R5 needs transportation to accommodate a wheelchair and the facility staff did not arrange for a substitution transportation accommodating for R5.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 26-AS-20231121112922

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: WESTMONT OF MILPITAS	FACILITY NUMBER: 435202744
	VISIT DATE: 04/25/2024

NARRATIVE

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Page 3 of 3.

Based on review at random facility’s Admission Agreements for 7 residents, “Transportation” under Admission Agreements on page 5 of 71 stated the facility will make available scheduled transportation to medical and dental appointments, shopping areas and various social activities. Scheduled transportation within twelve-mile radius of the Community is provided. There may be an extra charge for services outside the service area and for escort services for those who need assistance. Based on review of Appendix E Resident’s Personal Rights of the Admission Agreement on page 38 of 71, 7 out of 7 resident’s agreement stated the facility may not deny or restrict medical or nonmedical care that is appropriate to a resident’s organs and bodily needs.

Based on review of facility’s Plan of Operations updated on 7/3/2019, the facility will assist in arranging for a transportation provider for all other non-emergency transportation. Per document, it states “in all cases, the Community will ensure that the resident’s needs are met.”

Based on interviews and observation/inspection of the facility, the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D.
This report was reviewed with Administrator and a copy of the report was provided. Appeal Rights was provided.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 7

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
11/21/2023 and conducted by Evaluator Simranjit Rai

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20231121112922

FACILITY NAME:	WESTMONT OF MILPITAS		FACILITY NUMBER:	435202744
ADMINISTRATOR:	HARMS, STEVEN		FACILITY TYPE:	740
ADDRESS:	80 CEDAR WAY		TELEPHONE:	(408) 770-9575
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	225	CENSUS: 171	DATE:	04/25/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator, Greg Becker		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents in care are not provided adequate meals
Staff do not ensure there is enough food supplies at the facility for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator, Greg Becker and stated the purpose of today’s visit.

On 11/21/2023, the Department received a complaint with the above allegations. On 11/29/2023, the Department conducted an initial investigation at the facility.

Continuation on LIC 9099-C, Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 7

Control Number 26-AS-20231121112922

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: WESTMONT OF MILPITAS	FACILITY NUMBER: 435202744
	VISIT DATE: 04/25/2024

NARRATIVE

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Page 2 of 3.

Residents in care are not provided adequate meals.
It was alleged the meat was tough, hard to chew, the meal portions were small, and vegetables were cooked until it had zero nutritional value.

On 11/29/2023, the Department interviewed the Culinary Director who oversees the food service. CD stated all meals are reviewed by a nutritionist every 3 months and the receipts are pre-approved by a nutritionist. CD stated the residents are able to make requests on how they want the meal to be served when placing the order with the server and if the cook is able to fulfil the request, then they will arrange the substitution. CD stated they prepare the meat as set forth under FDA guidelines and residents can request for chopped meat when placing the order for the food. CD stated they serve the portions as set forth by the nutritionist, but the resident can always ask for second servings.

On 12/19/2023, the Department interviewed 8 residents. 7 Out of 8 residents stated there was adequate meals at the facility. They stated they were served meals in good portion and the facility servers would bring them seconds if requested. Resident (R1) stated it is not easy to flag down a server for second servings since the servers are short staffed and by the time R1 requests for second serving, the kitchen is out of the special and facility staff will accommodate from standing menu.

On 4/18/2024, the Department interviewed 11 residents. 1 resident cooked their own meals and did not use the food service at the facility. 2 residents declined to make comments about the meals served at the facility. 8 Out of 11 residents stated there was adequate meals at the facility. 8 residents stated they were getting enough portions as their entrée for lunch and dinner service. 8 residents stated they were able to consume the meat and often chopped the meat themselves and vegetables were cooked to their preference.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 26-AS-20231121112922

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: WESTMONT OF MILPITAS	FACILITY NUMBER: 435202744
	VISIT DATE: 04/25/2024

NARRATIVE

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Page 3 of 3.

Staff do not ensure there is enough food supplies at the facility for residents in care.
It was alleged that the facility did not have enough food supply to cook meals for the residents.

On 11/29/2023, the Department interviewed the Culinary Director who oversees the food service. CD stated there are changes that are made on the meals served to the residents based on what is delivered to facility by the food vendor. CD stated once the staff accounts for the delivery, they are able to make changes to the menu and notify the residents of the change. CD stated the facility will always have 2 days of perishable food supplies and 7 days of nonperishable food supplies and 3 days of emergency food and water supply.

On 11/29/2023, LPAs observed the food supply in the pantry, freezer, fridge, and kitchen. LPAs observed 2 days of perishable foods, 7 days of nonperishable foods and 3 days of emergency food and water supply.

On 12/19/2023, the Department interviewed 8 residents. 7 out of 8 resident state the facility did have enough food supply to cook meals for the residents. Resident (R1) stated the facility did not have enough food supply since the resident was not able to order the special of the day, but the facility did provide a meal off of the standby menu while is always available for the resident.

On 4/18/2024, the Department interviewed 11 residents. 1 resident cooked their own meal and did not have facility provide meals to him/her. 2 residents declined to make comments about the food supply at the facility. 8 out of the 11 residents stated the facility did have enough food supply at the facility. 8 residents stated they were served their entrée during breakfast, lunch and dinner and facility had provided snacks in the dinning room at all times.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator, Gregory Becker and a copy of this report was provided.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 26-AS-20231121112922

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: WESTMONT OF MILPITAS	FACILITY NUMBER: 435202744
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/02/2024 Section Cited CCR 87465(a)(2)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a)(2) The licensee shall provide assistance ...In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidenced by: Based on record review and interview, the	1 2 3 4 5 6 7	Licensee/Administrator stated to submit a written plan of action understanding regulation and ensure transportation is provided for medical and dental care by POC due date. Licensee/Administrator agreed and understood.
	8 9 10 11 12 13 14	facility did not provide transportation or make arrangements when facility did not have a driver for the facility van wherein residents were asked to re-schedule or cancel medical appointments which poses/posed a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	At this time, the facility has hired a driver to drive the facility van and was present at the facilty during today's visit.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC9099 (FAS) - (06/04)

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