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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202780
Report Date: 12/16/2024
Date Signed: 12/16/2024 12:35:22 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
08/14/2024 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20240814112117
FACILITY NAME:SONNET HILLFACILITY NUMBER:
435202780
ADMINISTRATOR:LATU, JASMINEFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:80CENSUS: 43DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Health & Wellness Director Dominique FrommoTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility staff were not following infection protocol during the COVID outbreak.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Health & Wellness Director Dominique Frommo.

On August 14, 2024, the Department received a complaint alleging Facility staff were not following infection protocol during the COVID outbreak. It has been alleged facility staff did not wear masks during a covid outbreak.

On August 23, 2024 and December 4, 2024, LPA Manuel Monter interviewed Staff S1-S4, S7. All staff interviewed stated the facility is following covid protocols. All staff interviewed stated the facility did the following during a covid outbreak, which included but not limited to, wearing masks, using hand sanitizer, delivering meals to resident bedrooms, isolating covid positive residents and staff.
Page 1 Out of 2.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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 5
Control Number 26-AS-20240814112117
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: 12/16/2024
NARRATIVE
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LPA Monter interviewed ADM. ADM stated the facility provided To go boxes and disposable containers with food, for covid positive residents. ADM stated All staff were wearing masks and automated machines were in the 2nd and third floor. ADM stated Housekeeping, had disinfectant sprays as well. ADM stated they tested the whole community and staff. ADM stated covid positive staff were isolated. ADM stated they Contact family and contact their doctors. ADM stated they Test residents every 3 days.

LPA Monter interviewed residents R2-R9. 1 Out of 9 residents (R2) stated he/she doesn’t know what the facility did during a covid outbreak at the facility. 2 Out of 9 residents (R4, R7) stated they did not want to be interviewed. 5 Out of 9 residents (R3, R5, R6, R8, R9) stated they observed staff wearing masks during a covid outbreak.

On October 22 & November 12, 2024, LPA Monter interviewed staff S5 and S6. S5 stated the facility provided mask and hand sanitizer. S5 stated staff were masks during an outbreak. S6 stated he/she isn’t comfortable answering the question and stated she does not want to answer.

Based on a review of the facility’s infection control plan dated May 2022, the facility shall follow their county’s department of health instructions. The Policy also states staff will wear masks during the virus season/ viral outbreak.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, 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.

Page 2 Out of 2. END OF REPORT.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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 5
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
08/14/2024 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20240814112117

FACILITY NAME:SONNET HILLFACILITY NUMBER:
435202780
ADMINISTRATOR:LATU, JASMINEFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:80CENSUS: 43DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Health & Wellness Director Dominique FrommoTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility did not follow residents care plan, resulting in resident sustaining a fall
INVESTIGATION FINDINGS:
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On August 14, 2024, the Department received a complaint alleging Facility did not follow residents care plan, resulting in resident sustaining a fall.

On August 14, 2024, the Department received an incident report. The incident Report (IR) stated on August 13, 2024, at 2:34am-4:40am, while tending to multiple urgent resident calls, care givers heard a pounding coming from the first floor. It appeared to be R1’s Power of Attorney (POA) and family member at the front door. It was discovered that R1 had fallen, and it was discovered thought the POA’s private camera.

On August 23, 2024, LPA Manuel Monter interviewed Staff S1-S4, and ADM. S1, S4 and ADM stated resident R1 would get up at night multiple times at night. S1 stated when R1 moved in, R1 would get up 2-3 times a night. S1 - S3 stated the staff will also be on standby assist for R1 when he/she exits his/her room. S4 stated he/she works NOC shift but didn’t work on August 13, 2024.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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: 3 of 5
Control Number 26-AS-20240814112117
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: 12/16/2024
NARRATIVE
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On October 22, 2024, LPA Monter interviewed Staff S5. S5 stated he/she was working the night shift when R1 had fallen on August 13, 2024. S5 stated he/she and S6 were assisting a resident on the third floor, who needed assistance. S5 stated later that night R1's family member came to the facility and informed S5 and S6 that R1 had been on the floor for hours. S5 stated he/she ran upstairs to check on R1 and assisted him/her up.

On November 12, 2024, LPA Monter interviewed staff S6. S6 stated he/she was working the night shift when R1 had fallen on August 13, 2024. S6 stated he/she could not provide any details on what had occurred that night. S6 confirmed that R1 has the behavior of getting up at night 3-4 times at night.

Based on a review of R1’s care plan dated March 18, 2024. states R1 is a moderate fall risk- meaning R1 requires direct interventions that are customized to the identified risk factors. The care plan also states R1 needs standby assist with transferring, and R1 uses a walker to ambulate and has an occasional disturbed sleep pattern. This form states R1 requires status checks every 2 hours at night.

Based on a review of R1’s Physicians Report, dated September 20, 2023, R1 has a neurocognitive disorder. R1 is also a risk for falls if unattended.

Based on a review of evidenced provided, R1 was last seen by facility staff on August 12, 2024, at 11:21pm. Resident R1 fell on the floor, in his/her bedroom, on August 13, 2024, at 12:19am. Facility staff returned to R1’s bedroom and picked R1 up on August 13, 2024, at 3:47am.

The Department has investigated the above allegation. Based on records reviewed, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED.

This report was reviewed with Health & Wellness Director Dominique Frommo. A copy of the report & appeal rights were provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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 5
Control Number 26-AS-20240814112117
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/17/2024
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by:
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ADM stated she will send a written letter of understanding, explain how she will ensure the facility will ensure it will meet the care, supervision and services that meet the needs of the residents.
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Based on interviews conducted & evidence reviewed, R1 care plan states R1 requires status checks every 2 hours at night. R1 was last seen on 08/12/24 at 11:21pm and was check on again on 08/13/24 at 3:47am the following day. This poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5