435202818-7-8-2024-26-AS-JJIN-D7BVXH-20240719164933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202818
Report Date: 05/10/2024
Date Signed: 07/08/2024 04:02:25 PM

Unsubstantiated

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
01/24/2024 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20240124171324

FACILITY NAME:	OAKMONT OF SAN JOSE		FACILITY NUMBER:	435202818
ADMINISTRATOR:	PAULA SPANEK		FACILITY TYPE:	740
ADDRESS:	917 THORNTON WAY		TELEPHONE:	(408) 371-7100
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	92	CENSUS: 56	DATE:	05/10/2024
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Christopher Schuster		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff disclosed confidential information about other residents to a visitor

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

THIS IS AN AMENDED REPORT FROM 05/10/2024. Licensing Program Analysts (LPAs) Christine Dolores and Grace Donato arrived unannounced to deliver the finding for the above allegation. LPA met with Business Office Director, Francisco Sudiacal.

On 01/24/2024, the Department received a complaint alleging staff had disclosed confidential information about other residents to a visitor at the facility. On 02/02/2024, the initial complaint investigation was conducted.

The following documents were obtained for this investigation to include resident roster, staff schedule for this week for Memory Care and Assisted Living, R1 – R5’s emergency contact information, physician’s report, individualized service plan, and progress notes from October 2023 – January 2024. SEE LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

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 2

Control Number 26-AS-20240124171324

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: OAKMONT OF SAN JOSE	FACILITY NUMBER: 435202818
	VISIT DATE: 05/10/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

THIS IS AN AMENDED REPORT FROM 05/10/2024.

It was alleged that on the first week of December 2023 a staff (S1) randomly shared confidential information to a visitor regarding incidents that occurred with residents - R1, R2, and R3.

Throughout the investigation, 7 staff members in Memory Care were interviewed. Based on interview, 7 out of 7 staff denied disclosing confidential information about other residents to a visitor. 7 out of 7 staff denied the observation of another staff member disclosing confidential information to a visitor. Based on interview, the PM shift staff and NOC shift staff conducts meetings in the dining room area between the time of 10:00pm – 10:30PM. This brief meeting is held in the dining room area because of the manager’s office is locked during the nighttime. Staff states that usually there are no visitors around that time, however, if there are visitors around at this time, staff try to be mindful about their endorsements.

Throughout the investigation, 3 witnesses were interviewed. Based on interview, 3 out of 3 witnesses denied being shared confidential information about other residents by a staff. 3 out of 3 witnesses denied observing staff share confidential information about other residents to a visitor.

Based on interview and record review, S1 was not provided any verbal or written disciplinary actions.

The Department has investigated the above allegation. Based on interview, record review and observation the Department has determined the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited 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 Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2