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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202818
Report Date: 07/18/2024
Date Signed: 07/18/2024 04:32:07 PM

Substantiated


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
06/02/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220602091807
FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:SILVA, FLAVIOFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 62DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kippie CastronovoTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Resident was unlawfully evicted while in care
INVESTIGATION FINDINGS:
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On 7/18/24, Licensing Program Analysts (LPAs) Grace Donato, Christine Dolores & Kiran Jain conducted an unannounced complaint investigation visit. LPA met with Executive Director Kippie Castronovo and explained the purpose of today's visit.

Regarding the allegation of resident was unlawfully evicted while in care, reporting party (RP) stated that an unlawful 30-Day Notice of Termination of Residence Agreement was served on May 13, 2022.

Based on interviews, LPA Dolores spoke with Health Service Director (HSD) regarding the Eviction on June 6, 2022. LPA informed HSD to resubmit this Eviction Letter to include more details of dates/times of specific events leading to the eviction. LPA informed HSD that once the eviction letter is re-written the 30 days would start over.

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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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-20220602091807
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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
VISIT DATE: 07/18/2024
NARRATIVE
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On June 12, 2022, AED emailed LPA a revised eviction letter dated June 13, 2022 to include all information requested.

On July 12, 2022, LPA spoke with AED to inform that the Eviction Notice dated July 13, 2022 is invalid due to the reasons listed below:

- The 30th day is incorrect.
- The eviction notice does not include the address of the State Local Long Term Care Ombudsman
- Does not list out information on resources in identifying alternative housing and care options, including public and private referral services and case management organizations.

While the letter that was sent on June 12, 2022 was previously approved, it was reviewed again by another Licensing Program Manager (LPM) at this time and it was deemed unlawful due to the reasons mentioned.

Therefore, based on interviews and records review and information collected, the above allegation is
determined to be SUBSTANTIATED. Deficiencies of the California Code of Regulations, Title, 22
cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties.

A copy of this report and the Appeal Rights are provided.

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SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20220602091807
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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2024
Section Cited
CCR
87224(d)(1)
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87224 Eviction Procedures (d)The licensee shall set forth in the notice to quit the reasons relied upon for the eviction...(1)The notice to quit shall include the following information:
This requirement was not met as evidenced by:
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Facility has already corrected the letter and provided it to the responsible party.
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Based on interviews & records review the facility gave the R1s responsible party an unlawful/invalid letter of eviction which poses an immediate 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.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3