435202818-6-9-2023-26-AS-KHOS-CSYKGH-20230620075333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202818
Report Date: 06/09/2023
Date Signed: 06/09/2023 05:14:27 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
06/01/2023 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20230601112624

FACILITY NAME:	OAKMONT OF SAN JOSE		FACILITY NUMBER:	435202818
ADMINISTRATOR:	SAN SOR		FACILITY TYPE:	740
ADDRESS:	917 THORNTON WAY		TELEPHONE:	(408) 371-7100
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	92	CENSUS: 63	DATE:	06/09/2023
		UNANNOUNCED	TIME BEGAN:	01:47 PM
MET WITH:	San Sor		TIME COMPLETED:	05:16 PM

ALLEGATION(S):

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Staff are not safeguarding resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst Ryker Heberle (LPA) opened a complaint investigation regarding the above allegation. LPA met with facility Administrator San Sor (Admin).

During the course of the investigation, LPA determined that there was currently only 1 resident (R1) at the facility who had expressed concerns over missing possessions at the facility. During interview with R1, R1 stated that sometimes their clothes go missing. R1 stated that the facility washes all of the clothes of residents together, and then when the clothes are returned, sometimes they are not given back everything that went to the wash. When asked to identify any articles of clothes that have gone missing, R1 stated that they were unable to personally identify articles of clothing that had gone missing. R1 stated that they do not believe anything is being stolen, just misplaced.
Continued in 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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-20230601112624

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: 06/09/2023

NARRATIVE

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The Department interviewed two individuals who were witnesses to R1 having possessions go missing (W1 & W2). W1 stated that they have observed R1's clothing go missing. W1 stated that they have taken pictures of all of W1's personal items, so they know when something goes missing. In an interview with W2, W2 stated that they have also observed items go missing, and have also observed R1 wearing other resident's clothing. W2 stated that the facility is quick to correct matters of missing or mistaken clothing when made aware. W2 stated that the facility offers to reimburse missing articles of clothing upon provision of proof of purchase. W2 stated that to their knowledge, none of R1's clothes have permanently gone missing, and that the clothing has always turned up in the facility eventually.

LPA reviewed R1's record to determine whether they have an inventory of personal property to cross reference with items present in R1's room. R1 opted out of the optional personal property inventory process upon admission into the facility. No inventory was found to exist for cross referencing.

In interview with Administrator, Admin confirmed that the facility is willing to reimburse lost articles of clothing upon provision of proof of purchase. Admin has stated that no proof of purchase evidence has been provided to the facility for replacement of missing items.

Based on information from interviews conducted with staff, residents, and witnesses and records reviewed, although the allegation listed above 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.

No deficiencies cited under Title 22 during this visit. Report was reviewed with and signed by Administrator San Sor and a copy was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC9099 (FAS) - (06/04)

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