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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202818
Report Date: 07/08/2024
Date Signed: 07/08/2024 04:04:20 PM


Document Has Been Signed on 07/08/2024 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:PAULA SPANEKFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 57DATE:
07/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Francisco SudiacalTIME COMPLETED:
04:20 PM
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Licensing Program Analysts (LPAs) Christine Dolores and Grace Donato arrived unannounced to conduct a case management – incident visit. LPA met with Business Office Director, Francisco Sudiacal.

This case management visit is a follow-up from the initial visit conducted on 01/17/2024.

On 01/17/2024, the Department was informed that resident (R1) immediately vacated and removed all his/her personal belongings from the facility on 12/28/2023.

It was alleged that the facility did not issue R1 a refund within 15 days. It was also alleged that the facility did not issue the full refund based on the Final Account Statement that was provided to R1’s designated power of attorney (DPOA) upon move-out.

The review of records shows that on 12/29/2023, the facility’s corporate office personnel emailed R1’s responsible party stating that a refund check will be received via mail within 15 days, however R1’s responsible party received the refund after 15 days.

Based on review of R1’s signed admission agreement, it is stated on page 9 #4(b) “within 30 days after your apartment has been vacated and property has been removed from it, Oakmont shall pay you and your representative a refund of any prorated unused portion of your final Monthly Fee payment, a prorated amount of the Community Fee …”

On 01/17/2024, the Executive Director was interviewed. Based on interview, R1 was exempt from the requirement to submit a 30-day written notice of termination per the admission agreement (page 7-8) to receive a refund. R1 was not exempt from receiving a refund within 30 days. SEE LIC809-C.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
VISIT DATE: 07/08/2024
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On 01/24/2024, a representative of R1 acknowledged the receipt of the refund. In the letter, the facility was questioned on the final account statement “variance – account balance – refund due” line.

The review of R1’s final account statement listed a “variance – account balance – refund due” line with a set amount.

Based on interview, staff originally calculated R1’s “variance – account balance – refund due” based off of the original community fee rate agreed upon during admission. During the course of the interview, it was disclosed that R1 was given a discount of the community fee rate. It was stated that upon review of the final account statement it was found that the facility had used the original community fee rate, instead of the discounted actual community fee payments received. Once the error was found, staff manually edited and recomputed R1’s refund based off of the actual community fee payments received.

Since R1 was discharged during the third month of residency, R1 was required to receive a refund of at least 40% of the preadmission fee (community fee) per Title 22 Section 87507(g)(5)(E)(2)(c).

R1’s actual refund amount was 40% of the three community fee installments paid on 10/01/2023, 11/15/2024, and 12/01/2023. R1 was also refunded a care credit.

Based on review of R1’s account ledger, the actual refund R1 received shows to be correct.

During visit, a complaint for control number 26-AS-20240124171324 was amended.

No deficiencies were cited today per California Code of Regulations, Title 22.

This report was reviewed with Business Office Director, Francisco Sudiacal and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC809 (FAS) - (06/04)
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