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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202772
Report Date: 10/03/2024
Date Signed: 11/20/2024 01:31:32 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
01/05/2022 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20220105145928
FACILITY NAME:OAKMONT OF SILVER CREEKFACILITY NUMBER:
435202772
ADMINISTRATOR:WILLIAM PENRODFACILITY TYPE:
740
ADDRESS:3544 SAN FELIPE ROADTELEPHONE:
(669) 288-5000
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:0CENSUS: 0DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Holly Suiter - TIME COMPLETED:
02:22 PM
ALLEGATION(S):
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Resident fell while in care
Staff left resident's unattended for extended period of time
Staff did not notify resident's authorized represntative of incident
Facility failed to readmit resident after discharge from hospital
Night staff is unavailable after hours
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced complaint investigation continuation regarding the above allegations. LPA met current ED/ADM Holly Suiter. The Facility has changed ownership.

On 10/3/2024, LPA Partoza continued with the complaint investigation. Based on research & interview, staff have changed and some of the residents have moved out and passed away. LPA tried to reach to the responsible party (RP) but was unsuccessful. 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. A copy of the report was provided to current ED/ADM Holly Suiter.
end of report
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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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