435202744-6-7-2024-26-AS-KHOS-D6JLF3-20240624084228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202744
Report Date: 06/07/2024
Date Signed: 06/07/2024 04:06:24 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
12/12/2023 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20231212112348

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: 170	DATE:	06/07/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Gregory Becker		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility's temperature is not within the required temperature
Facility ventilation is not working causing odor

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with (ADM) Administrator Gregory Becker.

Facility ventilation is not working causing odor

On December 12, 2023, the Department received a complaint alleging facility ventilation is not working causing odor.

On December 19, 2023, and April 18, 2024, The Department interviewed residents R1-R9. 7 Out of 9 residents interviewed stated they have not smelled any foul odors from the ventilation system. 2 Out of 9 residents interviewed stated the ventilation's system sometimes has a bad smell.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024

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-20231212112348

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: 06/07/2024

NARRATIVE

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On December 19, 2023, LPA Rai interviewed facility Maintenance Director; MD. MD stated the facility’s ventilation has no issues. MD stated the filters are replaced every year and were recently changed in November 2023.

On December 19, 2023, February 23, 2024, March 28, April 18, April 25 & May 9, 2024, the Department conducted unannounced visits to the facility. LPAs did not smell any foul odors coming from the ventilation system during these visits..

Based on a review of Facility work order, dated October 11, 2023, the facility had replaced its air filters on October 11, 2023.

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.

Facility's temperature is not within the required temperature

On December 12, 2023, the Department received a complaint alleging Facility's temperature is not within the required temperature.

On December 19, 2023, LPA Simi Rai interviewed residents R2-R9. 6 Out of 8 residents interviewed stated they had no issues with their room temperature. While interviewing residents, LPA noted R2-R9’s room temperature ranged from 74-78 degrees F.

On April 18, 2024, LPA Monter interviewed resident R1. R1 stated the fuse box inside his/her room began sparking and the power stopped. R1 stated the heater was not functioning. R1 stated he/she does not remember the exact date when the issue with his/her fuse box occurred. R1 stated he/she did inform the maintenance director (MD). R1 stated the facility did not provide another room as a temporary option. R1 stated the home did not offer blankets or space heaters. R1 stated the issue was resolved on December 11, 2023.

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20231212112348

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: 06/07/2024

NARRATIVE

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On June 3, 2024, LPA Monter interviewed facility Maintenance Director (MD). MD stated he/she does not remember the full details regarding R1’s heating issues. MD stated R1’s bedroom breaker had loose wiring and was informed of the issue on a Sunday, when the fire department came to the facility. MD stated he check R1’s bedroom the same day, then contacted an electrician who came fixed the issue the following day. MD stated R1 decline a heater and told MD that he/she doesn’t need it. MD stated he/she did report it to the Executive Director, but reiterated that nothing was written down as it was a minor incident that was resolved relatively quickly.

On June 7, 2024, LPA Monter interviewed former Executive Director (ED) Steven Harms. ED stated he did have discussion with MD regarding R1's room. ED stated he and the MD discussed providing ceramic heaters to R1, as they are safer than space heaters. ED stated he did not recall discussing with MD regarding R1 declining to use the portable heater. ED stated the conversations with MD were verbal and were not documented.

Based on a review of Local Fire Department report, dated December 3, 2023, Local fire department responded to an incident which occurred in R1’s bedroom. The report states the fire department advised the responsible person to have a licensed electrician service the panel.

The Department reviewed facility work order, dated December 5, 2023. The work order states R1’s bedroom’s power box was sparking on Sunday (December 3, 2023).

The Department reviewed a facility work order for a sparking power box for R1’s bedroom. The work order states it was opened on December 5, 2023, and closed on December 6, 2023.

The Department reviewed facility work order, dated December 11, 2023. The form states Maintenance Director (MD) reached out in regard to a bedroom, whose bedroom thermostat had no power. The form states the service was completed at 10:05am and there was no need to return.

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20231212112348

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: 06/07/2024

NARRATIVE

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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.

END OF REPORT

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024

LIC9099 (FAS) - (06/04)

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