435202744-4-25-2024-26-AS-RMAO-D5Q2ZG-20240528175017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202744
Report Date: 04/25/2024
Date Signed: 04/25/2024 05:15:57 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
06/23/2023 and conducted by Evaluator Simranjit Rai

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20230623152607

FACILITY NAME:	WESTMONT OF MILPITAS		FACILITY NUMBER:	435202744
ADMINISTRATOR:	BRAVO, SHERYL		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:	05:30 PM

ALLEGATION(S):

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Facility is not serving food at appropriate temperatures

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 June 23, 2023, the Department received a complaint of an allegation that the facility was not serving the food at appropriate temperature.

On June 30, 2023, LPA Chang conducted an initial investigation visit. LPA interviewed 2 staff and 2 residents. LPA toured the main kitchen, assist living unit dining room and memory care unit dining room.

Continuation in LIC 9099-C, Page 1 of 2.

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: 1 of 2

Control Number 26-AS-20230623152607

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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On June 30, 2023, around 9:10AM, LPA Chang toured and inspected the facility main kitchen and main dining room and interviewed a staff (S1). S1 stated the facility breakfasts were served from 7:30AM to 9:30AM, lunches were served from 11:30AM to 01:30PM, and dinners were served from 4:30PM to 6:30PM. S1 stated facility residents pick up their breakfast food at the food service counter. S1 stated there are staff serve the food at the food service counter during lunches and dinner.

LPA toured the memory care unit dining room and Kitchenette. Staff S1 stated the food was cooked in the facility main kitchen and was transported to memory care unit Kitchenette via hotbox. S1 stated the food was kept warm in the hotbox. Juices and drinks were observed kept in the refrigerator.

On June 30, 2023, and April 18, 2024, the Department interviewed 13 residents, R1-R13. 6 Out of 13 residents interviewed stated the food was hot and they had no complaints. 4 Out of 13 residents stated the food was not hot enough but staff did offer to heat it up if they requested. 1 Out of 13 residents stated does not eat food the facility provides and makes his/her own food. The remaining 2 Out of 13 residents stated they did not want to be interviewed.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

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)

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