435202744-10-18-2023-26-AS-KHOS-CX4KSU-20231030081008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202744
Report Date: 10/18/2023
Date Signed: 10/18/2023 04:57:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/14/2021 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20210514144310

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: 160	DATE:	10/18/2023
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Mark Baddas		TIME COMPLETED:	01:38 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not maintain adequate staffing to meet resident's needs.
Facility does not have planned activities for the residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced complaint investigation visit to deliver the investigation finding, and met with Current Executive Director (CED) Mark Baddas.

On 05/14/2021, the Department received a complaint with two allegations that facility does not maintain adequate staffing to meet resident's needs and facility does not have planned activities for the residents.

On 05/19/2021, an initial investigation visit was conducted, ADM, 2 staff and 4 residents were interviewed. Resident Profile, Physician Report, and Service Evaluation Plans, Activities Calendar and Staff Schedule were obtained.

Continue on LIC9099-C. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

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-20210514144310

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: WESTMONT OF MILPITAS	FACILITY NUMBER: 435202744
	VISIT DATE: 10/18/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Facility does not maintain adequate staffing to meet resident's needs:

On 05/19/2021, the Department interviewed Executive Director (ED) Dimple Kamdar. ED stated there were 3 residents in memory care unit, 1 resident in assisted living unit and 8 residents in independent living unit. ED stated the facility was actively hiring new staff because the facility just opened. ED denied the facility had low staff ratio because the facility only had 3 residents in memory care unit, and 1 resident in assisted living unit. ED stated the facility had new hired staff on training and another two new staff were just hired. ED stated there were 1 Med Tech/Caregiver, 1 nurse, and ED on duty for this shift not including house keepers and kitchen staff. On the same day, Med Tech (S1) was interviewed. S1 stated the facility had sufficient staff to take care of residents, most of time there were one care staff in memory care unit and one care staff in assisted living unit.

On the same day, the Department interviewed 4 residents (R1 - R4). 4 Out of 4 residents stated that their needs were met, and they were taken well care of.

On reviewing the documents, the facility had 5 care staff in April 2021 and 4 care staff in May 2021 to take care of residents. Based on the care staff schedule, the facility had at least one care staff at any time. Some of the time, the facility had one care staff at the facility, and he/she needed to take care of both sides of the memory care unit (MC) and assisted living unit (AL).

Based on the interviews conducted and documents reviewed, Often times the facility had two care staff on duty, but some of the time the facility had one care staff on-duty and he/she needed to take care of both MC and AL units. ED stated the facility only had 4 residents in MC and AL units, he/she and other directors also helped to take care of residents. ED stated the facility had new staff on training and another two staff had just been hired. ED stated the facility encouraged the care staff to take overtime to take care of residents. ED stated the facility tried to maintain 2 care staff at AM and PM shifts by having staff working overtime. S1 stated the facility had sufficient staff to take care of residents. Both ED and S1 stated the facility had sufficient staff to take care of current residents.

Continue on LIC9099-C. Page 2 of 3.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20210514144310

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: WESTMONT OF MILPITAS	FACILITY NUMBER: 435202744
	VISIT DATE: 10/18/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Facility does not have planned activities for the residents:

On 5/19/2021, the Department interviewed ED. ED stated the facility had a full time Activities Director Regina Brigham (S2), and a wide variety of activities were offered. On the same day, the Department interviewed S2. S2 stated the facility had Monthly Activity Calendar posted in advance. The facility had daily activity postings and offered text reminders to residents if they would like to participate. S2 stated he/she talked to residents at breakfast about activities planned for the day. S2 tried to get to know the residents on an individual basis to see what they would like to do. R1 likes puzzles and drawing, R2 likes exercise activities and just talking, R4 likes card games, and R3 likes quiet time.

On the same day, the Department interviewed 4 residents. 4 out of 4 residents stated the facility offered activities. 2 out of 4 residents stated they were not interested in the activities.

Reviewing the facility activity document, the facility offered a variety of activities and the facility had planned activities calendar. The Department observed residents participating in the activity in the facility during the visit.

Based on the documents reviewed and interviews conducted, the facility offered a variety of activities, but not all the residents were interested in participating in the facility activities.

The Department has investigated the above allegations. Based on documents reviewed, and interviews conducted, the Department found that the above allegations are 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 citations cited under California Code of Regulations Title 22. Exit interview conducted with Current Executive Director (CED). The report was provided to CED for signature. A copy of the report was provided to CED.

Page 3 of 3.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3