435202780-11-20-2024-26-AS-KHOS-DBCR7L-20241125114630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202780
Report Date: 11/20/2024
Date Signed: 11/20/2024 04:58:20 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
04/11/2024 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20240411164428

FACILITY NAME:	SONNET HILL		FACILITY NUMBER:	435202780
ADMINISTRATOR:	LATU, JASMINE		FACILITY TYPE:	740
ADDRESS:	429 MERIDIAN AVE		TELEPHONE:	(408) 731-0019
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	80	CENSUS: 42	DATE:	11/20/2024
		UNANNOUNCED	TIME BEGAN:	04:11 PM
MET WITH:	Jasmine Latu		TIME COMPLETED:	04:39 PM

ALLEGATION(S):

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Staff are not addressing resident's rash timely.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Executive Director (ED) Jasmine Latu.

On 4/15/2024, the Department received a complaint with the allegation that staff are not addressing resident's rash timely.

On 4/15/2024, the Department conducted an initial investigation visit.

LPA interviewed ED. and 2 staff, 6 residents.

Continue on LIC9099-C. Page 1 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

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 3

Control Number 26-AS-20240411164428

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: SONNET HILL	FACILITY NUMBER: 435202780
	VISIT DATE: 11/20/2024

NARRATIVE

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Staff are not addressing resident's rash timely:
On 4/15/2024, LPA interviewed Executive Director (ED) Jasmine Latu. ED stated the facility did not have an outbreak of skin rash. ED stated on 3/25/2024, staff S1 and S2 told ED that they might have rash from resident R1. ED stated he/she told them to see doctor to find out what is the issue. ED stated after S1 and S2 were checked by doctors and found they did not have rash.

ED stated R1 was checked by doctor on the week of 3/25/2024, and R1 was found not rash but was allergy. ED stated he/she contacted R1's family member (FM). ED stated FM told him/her that their family members have allergy to laundry detergents. ED stated FM brought doctor prescription over the counter allergy medications and over the counter creams for R1. ED stated FM suggested the facility to use All Free Clear laundry Pod which R1 is not allergy to. ED stated R1 is fine now. ED provided the email communication log with FM.

LPA interviewed Director of Medical Service (DMS). DMS denied the facility has outbreak of skin rash. DMS stated resident R1 has allergy but not rash..

LPA interviewed staff S1. S1 stated he/she does not have rash. S1 stated the facility does not have outbreak of rash.

LPA interviewed resident R1. R1 was talking something but was unable to answer questions.

LPA interviewed R1's roommate R2. R2 stated he/she does not have rash and does not know any one has rash.

LPA interviewed another 4 residents, 4 Out of 4 stated they don't have rash and they don't know any one has rash.

Based on the review of the facility communication log with R1's family on 3/25/2024, 4/5/2024, and 4/8/2024, the facility did some action to relieve R1's allergy.
Based on the interview and records reviewed, The facility conducted some actions for R1 and R1 did not have rash.
Continue on LIC9099-C. Page 2 of 3

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20240411164428

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: SONNET HILL	FACILITY NUMBER: 435202780
	VISIT DATE: 11/20/2024

NARRATIVE

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The Department has investigated the above allegations. Based on the investigation, records reviewed, observation, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

No citations noted at today’s compliant investigation visit. Exit interview conducted with Executive Director (ED). This report was provided to review and for signature. A copy of this report was provided to ED.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3