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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202775
Report Date: 07/03/2025
Date Signed: 07/03/2025 02:02:46 PM

Unfounded


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
04/25/2025 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20250425154553
FACILITY NAME:WATERMARK AT ALMADEN, THEFACILITY NUMBER:
435202775
ADMINISTRATOR:COREY MILLERFACILITY TYPE:
740
ADDRESS:4610 ALMADEN EXPRESSWAYTELEPHONE:
(669) 258-4567
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:240CENSUS: 165DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Business Office Director, Melissa LummisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff are not answering resident's call button.
Facility staff are not providing incontinence care at night to residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Business Office Director, Melissa Lummis and stated the purpose of today’s visit.

On 4/25/2025, the Department received a complaint with the above allegations. On 5/2/2025, the Department conducted an initial investigation at the facility.

Continuation on LIC 9099-C, Page 1 of 3.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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-20250425154553
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: WATERMARK AT ALMADEN, THE
FACILITY NUMBER: 435202775
VISIT DATE: 07/03/2025
NARRATIVE
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Page 2 of 3.

Facility staff are not answering resident’s call button.

On 5/2/2025, the Department interviewed 1 staff (S1). S1 stated the call button system alerts the facility staff via pager every 5 minutes until the alert is not cleared. S1 stated the residents receiving incontinence care require facility staff to change incontinence products are often as necessary. S1 stated the facility staff will document when they have provided incontinence assistance to resident.

On 7/3/2025, LPA Rai interviewed 4 staff (S1-S4). Four out of four staff stated they do not have call buttons for residents that require incontinent care. Four out of four staff stated they have not seen or heard staff not answering resident’s call button.

On 7/3/2025, LPA Rai interviewed 5 residents (R1-R5). Five out of five residents refused to be interviewed during the visit.

Based on review of call button report for March 2025 and April 2025, facility staff are responding to resident’s call buttons and there hasn’t been one entry where the staff did not answer to a resident’s call button request.

Facility staff are not providing incontinence care at night to residents.

On 5/2/2025, the Department interviewed 1 staff. S1 stated the residents receiving incontinence care require facility staff to change incontinence products are often as necessary. S1 stated the facility staff will document when they have provided incontinence assistance to resident.

On 7/3/2025, LPA Rai interviewed 4 staff (S1-S4). Four out of four staff stated they have not seen or heard facility staff not provide incontinence care at night. Three out of four staff stated they have seen some residents that require attention in the morning with incontinence care, but that does not meet the resident has not been provided with incontinence care at night.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20250425154553
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: WATERMARK AT ALMADEN, THE
FACILITY NUMBER: 435202775
VISIT DATE: 07/03/2025
NARRATIVE
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Page 3 of 3.

On 7/3/2025, LPA Rai interviewed 5 residents (R1-R5). Five out of five residents refused to be interviewed during the visit.

Based on review of 5 random residents (R1-R5) who require incontinent care, 5 out of 5 residents received incontinent care at night in April 2025.

The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Business Office Director, Melissa Lummis and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3