435202744-9-15-2024-26-AS-RMAO-D9BU7J-20240921152003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202744
Report Date: 09/15/2024
Date Signed: 09/15/2024 02:18:17 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 Maria Partoza

COMPLAINT CONTROL NUMBER: 26-AS-20231212142830

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:	DATE:	09/15/2024
		UNANNOUNCED	TIME BEGAN:	12:08 PM
MET WITH:			TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility call system is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to continue and deliver the finding of the complaint received by the department on 12/12/2023 regarding the allegation that the facility's call system is in disrepair. LPA met with Executive Director/Admnistrator Gregory Becker.

On 12/19/2023, LPA Rai, conducted the initial investigations and interviewed 8 residents (R1 to R8), Staff 1 and 2 (S1 to S2). LPA Rai requested documents to include LIC 500 the resident roster, and the call bell system Invoices with a deadline of December 21, 2023 fron the Operatons Specialist.

On 4/19/2024, LPA Partoza, continued the invesigation and reviewed the statements of the individuals who were interviewed.

page 1 (see LIC 9099C for page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2024

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 3

Control Number 26-AS-20231212142830

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: 09/15/2024

NARRATIVE

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On 12/19/2023, LPA Rai conducted interviews with residents ( R1 to R8). Based on interview of R1 to R5 and R8, R1 to R5 and R8 does not use an emergency call pendant. R6 & R7 - uses an emergency call pendant, R1 to R8 have an emergency call button inside the bathroom that can be used in case of emergency. The emergency has a cord that residents need to pull for any life threatening situation.

On 9/15/2024 at 12:10 p.m. LPA Partoza conducted additional interviews with staff (S3 to S7). Staff 4 (S4) demonstrated to LPA how the check in button works.

At 12:10 p.m. LPA interviewed staff 4 (S4). S4 stated that the check in buttons is used to notify the facility that the resident is present in their apartment. A report listing the residents who checked in is printed each morning and if a resident's name does not appear on the list the front desk calls the resident and have a staff check on the resident. Residents should check in between the hours of 12:00 a.m. to 9:00 a.m. each day.

At 12:15 p.m. LPA was accompanied by staff 3 (S3) to the memory care area and asked S3 to accompany LPA and demonstrate how the call button works.

At 12:30 p.m. LPA interviewed S5, and S5 demonstrated how the check in button works, how they turn it off. In the memory care unit the staff are the ones who alerts the front desk and uses the check in buttons, the check in button has a red cord that they pull and is located in the bathroom. A red light flashes if the battery is low.

At 12:45 p.m LPA interviewed staff 6 and 7(S6 and S7) and accompanied LPA to 2 resident's unit, of which one was recently vacated and 1 was occupied. S6 stated that the call buttons are used to check that the resident is in their room. S6 demonstrated that each resident has a pendant that is used to call the caregivers. S7 stated the check in is not for the caregivers but is used to account for the resident. S7 demonstrated how the check in button works and the pendant for each resident when pushed goes directly to the caregiver's pager. S6 demonstrated how a caregiver turns off the pendant. S5 demonstrated how the caregiver receives notification from the pendant. S6 and S7 stated that red light flashing from the check indicates low battery and maintenance is called to replace the battery.

page 2 of 3 see LIC 9099C

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20231212142830

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: 09/15/2024

NARRATIVE

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At 1:25 p.m. Executive Director/Administrator (ED/ADM) arrived at the facility. LPA interviewed ED/ADM and stated that the facility has the list (a copy provided) of the resident's who checked in from 12 midnight to 9:00 a.m. ED/ADM goes through the list and submit the report by 10:00 a.m. and saves the report in the office and is used as additional safety measure. ED/ADM stated if the battery is low, the system generates a report which unit needs the battery replaced.

Based on interviews, document reviews, and observation, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited during today's visit per California Code of Regulations (CCR) Title 22. An exit interview was conducted with Executive Director/Administrator Gregory Becker and a copy of the report was provided.

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end of report

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2024

LIC9099 (FAS) - (06/04)

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