435202818-8-26-2024-26-AS-KHOS-D8JRH7-20240827130152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202818
Report Date: 08/26/2024
Date Signed: 08/26/2024 12:33:14 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
05/23/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220523155841

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):

1
2
3
4
5
6
7
8
9

Staff did not accord resident dignity and respect.
Staff did not respect resident's personal privacy

INVESTIGATION FINDINGS:

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

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 did not accord resident dignity and respect & staff did not respect resident's personal privacy, Reporting Party (RP) stated that RP sent staff member S1 and S3 requests that only essential care visits would be allowed. On 05/13/2022 at 10:00 a.m., there was knocking at the resident's (R1) apartment and RP looked through the peephole and saw S1. RP told S1 if they can please call and discuss the needs over the phone because S1 blurts things out and there's no privacy. RP did not give permission for S1 to enter and just instantly put the master key in the lock.

page 1 of 3

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)

Page: 1 of 3

Control Number 26-AS-20220523155841

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

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

R1 woke up when S1 entered the apartment. S1 went up to R1 and asked if R1 wanted to speak to R1s family member. R1 said yes, and S1 went down to get the iPad. S1 arrived 30 minutes later with the iPad and RP gave permission to enter the apartment. S1 observed R1 to be asleep and left.

LPA Dolores interviewed three staff members. S1 mentioned that he/she knocked on the door and RP did not open the door and was told to get out of there. S1 told RP that they needed to talk to R1 because a family member wanted to FaceTime with R1, RP still did not open the door and S1 entered his master key in the lock. S1 states he/she did not forcefully opened the door and entered in the room slowly. S1 did not force or push the door open. For their (residents) privacy, they knock on the door. If they don't answer, they open the door to see if they're okay. RP said get out of here and S1 said he/she needed to talk to R1. RP questioned why they put the master key in. S1 explained that after they knock 3 times and they don't answer, they need to open the door to check on the resident.

Another staff member (S2) confirmed S1s actions. S2 stated that they were coming up to R1s room with the iPad to Facetime R1s family. On the door there are notes/instructions for caregivers to knock softly. S1 knocked softly and they didn’t hear anything. After a couple of knocks they heard the RP say, “hello how can I help you?” S1 introduced himself/herself and S1 opened the door. S1 walked inside and said I have a question for R1. S2 heard S1 ask R1 a question. S1 said they’ll come back in 15 minutes. S1 didn’t forcefully push the door because when S1 opened the door, RP already said "hi how can I help you". RP can see through the peep hole of anyone at the door. S2 also added that usually whenever they go to the door, they have to knock and then introduce themselves. S2 said that what they trained to do is first knock on the door and usually wait for a hello. When it’s locked, they wait for the resident to come to the door, if they know resident is not able to get up on their own and needs help getting up, they'll use their key and open it slowly. If the resident says they’ll be right there, they’ll wait. The residents are really good about letting staff know if they want us to wait outside and they’ll be right there.

page 2 of 3

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)

Page: 2 of 3

Control Number 26-AS-20220523155841

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

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

Staff member (S3) stated that they never observed a staff force themselves inside a resident’s room. In assisted living they’re alert and oriented. S3 checks in with them once in a while and they'd inform if there is anything is wrong. They knock on the door for privacy. Some of the residents doesn’t like the doorbell and others do. They get to know the residents to know their preference. If they need to enter, the staff knows to just knock. After they knock, they'll introduce themselves. They don’t just barge in. They know not to do that.

Based on interviews & records review, the department has determined that although the allegations may have happened or are 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.

page 3 of 3

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)

Page: 3 of 3