435202818-8-26-2024-26-AS-KHOS-D8JRNW-20240827131101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202818
Report Date: 08/26/2024
Date Signed: 08/26/2024 12:34:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220712170531

FACILITY NAME:	OAKMONT OF SAN JOSE		FACILITY NUMBER:	435202818
ADMINISTRATOR:	SILVA, FLAVIO		FACILITY TYPE:	740
ADDRESS:	917 THORNTON WAY		TELEPHONE:	(408) 371-7100
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	92	CENSUS: 65	DATE:	08/26/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kippie Castronovo		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff engaged in a verbal altercation in the presence of resident's.

INVESTIGATION FINDINGS:

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On 8/26/2024, Licensing Program Analysts (LPAs) Grace Donato & Christine Dolores 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 staff engaged in a verbal altercation in the presence of residents, Reporting party (RP) stated that during the incident, a staff (S1) was with another staff (S6) and had entered in the apartment when handing the medication to the RP for discharge. RP placed his/her hand on the door of the apartment and asked S1 if they can discuss this. S6 said RP was not listening to S1. RP states to have placed his/her hand on the door which can prohibit staff from exiting the room, so they can talk about the situation. RP states S1 opened the door and started screaming at her more in the hallway. A resident (R1) was a witness and RP states R1’s jaw dropped.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20220712170531

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
, CA

FACILITY NAME: OAKMONT OF SAN JOSE	FACILITY NUMBER: 435202818
	VISIT DATE: 08/26/2024

NARRATIVE

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LPA Dolores interviewed five residents one of which is R1. R1 stated that he/she has never observed or heard of a verbal altercation with staff and a resident/family member at the facility. R1 also states to have never observed or heard of a verbal argument that occurred at the facility with staff and a resident/family member. R1 states to be perfectly happy and has no concerns with the staff. LPA Dolores also interviewed staff, one of which is S1. S1 stated to not consider these interactions as an altercation, but as a conversation they had. S1 added that on 07/11/2022, RP was requesting for all of R2s medications. There was a misunderstanding with the medications. On 07/12/2022, S1 brought the bottles of medications to R2s room. Another staff member (S2) added that there was no altercation. Med tech's were pressured by RP to sign off meds. Then reported that they demanded the meds. When RP was in possession of the meds there was no provided care. S2 clarified that they will provide the care. The conversation happened in the room not in the hallway. No one was raising their voice.

Additionally, other residents interviewed R5, R6 & R7 mentioned that they were not aware of any incidents or altercation regarding a family member and a staff. Also staff members S3, S4 & S5 added that they have not witnessed, observed, or heard of a verbal altercation/argument with a staff member and resident/family member at the facility while on duty. There weren’t also any concerns brought to them by any staff or resident.

Based on interviews & records review, the department has determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

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