435202772-7-18-2025-26-AS-MPAA-DKETKV-20250810144835

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202772
Report Date: 07/18/2025
Date Signed: 07/18/2025 03:34:03 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
05/22/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20230522094543

FACILITY NAME:	OAKMONT OF SILVER CREEK		FACILITY NUMBER:	435202772
ADMINISTRATOR:	BAGHERI, TAYEBEH		FACILITY TYPE:	740
ADDRESS:	3544 SAN FELIPE ROAD		TELEPHONE:	(669) 288-5000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	0	CENSUS: 0	DATE:	07/18/2025
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Minnie Weber		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident was assaulted by another resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint visit and met with Executive Director Minnie Weber. On 05/22/2023, the department received a complaint with the above allegation. On 06/01/2023, LPA Marrufo conducted an initial complaint investigation visit.

Resident R1’s Individualized Service Plan (ISP) states R1 has combative behavior and will receive monitoring and assistance when displaying combative behaviors. R1’s ISP states staff will observe R1’s behaviors and guide as needed, as well as provide additional assistance and supportive environment. R1’s ISP states R1 wanders only within the common areas of the secured community; therefore, no additional staff time is needed. R1’s ISP states R1 will receive observation and assistance when wandering and staff will cue or redirect for safety.

See LIC9099-C pages for more information. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025

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-20230522094543

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: OAKMONT OF SILVER CREEK	FACILITY NUMBER: 435202772
	VISIT DATE: 07/18/2025

NARRATIVE

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R1’s Behavior Intervention Record (BIR) states that on 05/19/2023 at 7:00 PM, R1 locked himself/herself inside R2’s living unit and was pushing and grabbing resident R2 while preventing R2 from opening the door or leaving the room. The BIR states staff tried to convince R1 to open the door and were successful in doing so.

During visit on 06/01/2023, LPA Marrufo interviewed staff S1 and S3 and attempted to conduct a telephone interview with S2.

During interview, S1 stated that prior to R1 entering R2’s living unit, R1 was very agitated with S1 and S2. S1 stated R1 was telling S2 to get out. Both S1 and S2 decided to give R1 time. S1 let the medication technician know that R1 was very agitated. S1 stated to have endorsed R1 to S2 so that S1 could assist another resident. According to S1, S2 went to assist another resident. When S2 came out of another resident’s room, S2 saw R1 walking into R2’s room.

S1 stated that S2 waved over to S1 and said that R1 had entered R2’s living unit and locked the door. S1 stated to have used his/her key to unlock R2’s door. R1 was leaning against the door. S1 and S2 were able to slightly open the door. S1 asked R2 to open the door. S1 could see from the slight opening of the door that R1 was preventing R2 from opening the door by pushing R2 and grabbing R2’s arms. S1 observed R1 preventing R2 from opening the door.

S1 stated to have convinced R1 that his/her child was at the facility. R1 opened the door and S1 ran into R2’s apartment and locked the door from within while S2 was outside of the door with R1.

S1 observed R2 to be shaking and crying. S1 attempted to calm down R2. S1 did not notice any injury on R2. S1 stated that R2 reported that R1 had hit R2.

LPA Marrufo made an attempted telephone interview with S2 on 06/01/2023 but was only able to leave a voicemail message.

Page 2 of 3.

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20230522094543

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: OAKMONT OF SILVER CREEK	FACILITY NUMBER: 435202772
	VISIT DATE: 07/18/2025

NARRATIVE

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On 06/01/2023, S3 stated that during lunch, R1 grabbed R2’s wrist. S3 stated that staff in the dinning room stopped R1.

Based on information from interviews conducted with staff, and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated.

No deficiencies were cited under California Code of Regulations Title 22.

This report was reviewed with Executive Director Minnie Weber and a copy of this report was provided.

Page 3 of 3.

END REPORT

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025

LIC9099 (FAS) - (06/04)

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