435202775-12-16-2024-26-AS-KHOS-DCVMMZ-20250113084445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202775
Report Date: 12/16/2024
Date Signed: 12/16/2024 05:31:02 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
01/26/2023 and conducted by Evaluator Simranjit Rai

COMPLAINT CONTROL NUMBER: 26-AS-20230126091157

FACILITY NAME:	ATRIA ALMADEN		FACILITY NUMBER:	435202775
ADMINISTRATOR:	KRIS WALUSZKO		FACILITY TYPE:	740
ADDRESS:	4610 ALMADEN EXPRESSWAY		TELEPHONE:	(669) 258-4567
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	240	CENSUS: 147	DATE:	12/16/2024
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Executive Director, Corey Miller		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff gave resident expired medication.
Facility staff are not properly dispensing medications to residents.
Facility staff are not properly managing residents' medications.
Facility staff are not ensuring that residents are adequately fed.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Executive Director, Corey Miller and stated the purpose of today’s visit.

On 1/26/2023, the Department received a complaint with the above allegations. On 1/31/2023, the Department conducted an initial investigation at the facility.

Continuation on LIC 9099-C, Page 1 of 4.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

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 4

Control Number 26-AS-20230126091157

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: ATRIA ALMADEN	FACILITY NUMBER: 435202775
	VISIT DATE: 12/16/2024

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

Page 2 of 4.
Facility staff gave resident expired medication.
It was alleged the medication carts which stored the resident’s medication had expired medication.

On 1/31/2023, the LPA observed the medications in the medication cart and did not observe expired medications.

On 12/16/2024, LPA Rai interviewed 3 staff (S1-S3) who were working at the facility during the time of the complaint was received on 1/26/2023. Three of three staff stated they have not seen or heard of residents being administered expired medication. S3 stated the Medication Technicians administer the medications and S3 has seen the Medication Technicians follow the facility’s police on administering medications to the residents.

On 12/16/2024, LPA Rai interviewed at random 3 residents residing in Memory Care unit when this complaint was initially received by the Department. Two out of three residents refused to be interviewed. One out of three residents were not able to answer LPA’s questions related to this complaint investigation.

Facility staff are not properly dispensing medication to residents.
It was alleged Medication Technicians (Med-Tech) would leave the resident’s medication on the tables, assessable to residents.

On 1/31/2023, the Department interviewed S3 who was designated to administer medication to residents. S3 stated Assisted Living residents came to Medication Room to administer medications and MedTech would deliver to Memory Care residents.

On 1/31/2023, the LPA observed the resident rooms and dining rooms. LPA did not observe medications left on the table.

On 12/16/2024, LPA Rai interviewed at random 3 residents residing in Memory Care unit when this complaint was initially received by the Department. Two out of three residents refused to be interviewed. One out of three residents were not able to answer LPA’s questions related to this complaint investigation.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20230126091157

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: ATRIA ALMADEN	FACILITY NUMBER: 435202775
	VISIT DATE: 12/16/2024

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

Page 3 of 4.
On 12/16/2024, LPA Rai interviewed 3 staff (S1-S3) who were working at the facility during the time of the complaint was received on 1/26/2023. Three of three staff stated they have not seen or heard of staff not properly dispensing medication to residents. All three staff stated they have not seen resident’s medication on table or counters accessible to residents. S3 stated the Medication Technicians administer the medications to the resident directly and they observe the resident taking the medication. S3 stated the Medication Technicians note residents that refuse medication as well. S3 has seen the Medication Technicians follow the facility’s police on administering medications to the residents.

Facility staff are not properly managing resident’s medications.
It was alleged the Medication Administered Record (MAR) was incorrect, the medication was logged as administered, but the medication was refused or left in the medication cart.

On 1/31/2023, the Department interviewed 3 staff members (S1-S3). Two staff did not answer questions related to this allegation. S3 stated everything was documents correctly in the MAR. S3 stated staff would try three times if resident refused to take medications. S3 stated when resident refused to take medication, it was reported to the Director and resident’s physician.

On 1/31/2023, the LPA observed the medications in the medication cart and did not note any issues wherein the MAR was incorrect.

Facility staff are not ensuring that residents are adequately fed.
It was alleged resident R1 and R2 did not receive the assistance feeding lunch due to be short staffed, so the residents were not fed lunch.

On 1/31/2023, the Department interviewed 3 staff members. One out of three staff stated all residents received and were fed meals. S1 stated there are dedication caregivers to help residents for the meals and there is no shortage of facility staff at the time.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20230126091157

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: ATRIA ALMADEN	FACILITY NUMBER: 435202775
	VISIT DATE: 12/16/2024

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

Page 4 of 4.
On 1/31/2023, the Department interviewed 3 residents (R1-R3). R1 stated he/she always had meals in the dining room. LPA observed a designated caregiver with R1. R2 was not able to speak with LPA due to language barrier. R3 stated all the residents eat meals in the dining room and receive their full meals.

On 1/31/2023, the LPA observed the resident rooms and dining rooms. LPA did not observe meals left on the table unconsumed.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Executive Director, Corey Miller and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4