435202780-5-21-2024-26-AS-JJIN-D72UVK-20240710155517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202780
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:08:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2023 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20230125092006

FACILITY NAME:	SONNET HILL		FACILITY NUMBER:	435202780
ADMINISTRATOR:	JASMINE LATU		FACILITY TYPE:	740
ADDRESS:	429 MERIDIAN AVE		TELEPHONE:	(408) 731-0019
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	80	CENSUS: 37	DATE:	05/21/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Johanna Moon		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff handle resident in a rough manner
Staff do not accord dignity in their relationship with a resident in care

INVESTIGATION FINDINGS:

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On 5/21/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Business Office Manager, Johanna Moon and LPA explained the purpose of today's visit

LPA Donato visited the facility and interviewed 3 staff members and 1 resident. LPA attempted to interview other residents but due to cognitive issues, are not able to answer LPAs questions.

Regarding the allegation of staff handled resident in a rough manner and staff do not accord dignity in their relationship with a resident in care, reporting party (RP) stated that a staff (S4) agitates a resident (R1). They were physically pushing each other’s hands till they ended up on the floor. Another staff member (S5) witnessed the altercation. RP believes that R1 was confused, and that the staff could no longer deal with him.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

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 5

Control Number 26-AS-20230125092006

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: SONNET HILL	FACILITY NUMBER: 435202780
	VISIT DATE: 05/21/2024

NARRATIVE

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LPA Heberle interviewed the administrator (ADM), and it was mentioned that sometimes a resident is mad because of lost memory. It was another patient (R2), R2 would sometimes grab and shake staff members, but never hit anybody. Does not remember R2 ever hitting other residents but hit staff a month ago. Another resident R1 is violent fairly frequently but has never hit another resident. LPA Donato also confirmed in another interview that R1 has not hit or had an altercation with a staff member.

Based on interviews, the department has determined that although these allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2023 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20230125092006

FACILITY NAME:	SONNET HILL		FACILITY NUMBER:	435202780
ADMINISTRATOR:	JASMINE LATU		FACILITY TYPE:	740
ADDRESS:	429 MERIDIAN AVE		TELEPHONE:	(408) 731-0019
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	80	CENSUS: 37	DATE:	05/21/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jasmine Latu		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff do not have medication training
Staff mismanage residents medication
Staff not notifying residents representatives of unusual incidents
Facility does not provide adequate nutricion to residents in care
Facility has foul odor

INVESTIGATION FINDINGS:

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On 5/21/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Business Office Manager , Johanna Moon and LPA explained the purpose of today's visit.

Regarding the allegation of staff do not have medication training, RP stated that the Registered Nurse (RN) has staff prepare and dispense medication to the residents, and they have not been trained.

Based on records review, the said staff members were being trained during this time. Training certificates and logs show that these staff members who dispense medication were being trained since October 2022 up until they finished the certification training in February 2023.

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 26-AS-20230125092006

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: SONNET HILL	FACILITY NUMBER: 435202780
	VISIT DATE: 05/21/2024

NARRATIVE

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Regarding the allegation of staff mismanage residents’ medication, RP stated that a staff (S1) who works morning shift, prepares the PM medication. Many times, S1 does not have residents multi vitamins, cough syrup, CVD (melatonin), or their pack of medication prepared. Staff (S6) do not always give resident PRN medication.

LPA Donato was able to interview S1, and it was mentioned that since the multivitamins are PRNs, if it runs out and responsible parties don’t refill it then they won’t be able to give it to residents. Responsible persons or family members are just advised since it’s a PRN medication and not routine ones.

Regarding the allegation of staff not notifying residents representatives of unusual incidents, RP stated that care giving staff was told not to report violent incidents to the residents' responsible parties. Management directed staff to not notify the residents’ family or representatives about the incidents.

During the interviews, all three staff members said that they do report the incidents to managers. S2 mentioned that they fill out a form to write what they had witnessed. This is then submitted to the management who does the final report. ADM mentioned too that they have the caregivers write the report as to what they remember. Management are the ones who call the physician (PCP) and responsible parties.

Based on incident reports sent by facility, it showed that responsible parties are contacted by the facility to make them aware of the incident.

Regarding the allegations of facility does not provide adequate nutrition to residents in care and facility has foul odor, RP stated that the residents do not get snacks or fruit and there was a day when the kitchen smelled like dog.

The three staff members mentioned that residents always get snacks. S1 said that there are always snacks provided. Like crackers, fruits and yogurt. Provided 3x or sometimes more when residents ask for second helpings. S3 also mentioned that when snacks are out, they just call the kitchen to provide food.

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SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 26-AS-20230125092006

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: SONNET HILL	FACILITY NUMBER: 435202780
	VISIT DATE: 05/21/2024

NARRATIVE

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LPA also observed that upon entry in the facility, the lobby has a coffee maker, snacks supply and fruits. On the second floor in memory care, LPA also observed a cabinet that has some snacks and fruit bowl and also a refrigerator where there's custard & drinks.

Regarding the allegation of facility has foul odor, RP mentioned that the cook has a dog that is kept in the office which is next to the kitchen. There was a day when the kitchen smelled like dog.

LPA observed the facility and it was clean and no smell of odor other than the food being prepped in the kitchen. ADM mentioned that the dog was a small dog that always stays in the office and is not allowed in the kitchen.

Based on interviews, records review and observations, the department has determined that these allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED.

Report is reviewed and copy is provided.

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SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5