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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202874
Report Date: 10/17/2024
Date Signed: 10/17/2024 03:09:34 PM

Unfounded


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
10/07/2024 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20241007160553
FACILITY NAME:MORNINGSTAR MEMORY CARE AT SAN TOMASFACILITY NUMBER:
435202874
ADMINISTRATOR:PADILLA SANCHEZ, KENIAFACILITY TYPE:
740
ADDRESS:3930 WILLIAMS RDTELEPHONE:
(669) 201-2015
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:82CENSUS: 28DATE:
10/17/2024
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Kenia SanchezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff left medication unattended and accessible to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christine Dolores and Santino Fortes arrived unannounced to open the initial complaint investigation. LPAs met with Executive Director, Kenia Sanchez.

On 10/07/2024, the Department received the complaint. On 10/17/2024, the initial complaint investigation was conducted. Documents were obtained to include the staff schedule for September 2024, resident roster, and a staff member’s telephone number.

It was alleged that when staff (S1) assisted another resident, S1 had left "a stack" of bubble pack medications unattended and accessible to residents in care in the common area of the facility. Page 1 of 2.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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-20241007160553
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: MORNINGSTAR MEMORY CARE AT SAN TOMAS
FACILITY NUMBER: 435202874
VISIT DATE: 10/17/2024
NARRATIVE
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On 10/17/2024, 3 staff members were interviewed. Based on interview, S1 stated to be discarding the monthly cycle of medications on the desk in the common area. S1 stated the bubble packs of medications that were sitting on top of the desk were being discarded and were empty bubble packs of medications. S1 stated there were no medications in the bubble packs. S1 stated that a resident had a fall in the common area just a few feet away from S1 and S1 turned his/her back from the desk with the empty bubble pack of medications. S1 denied leaving the common area and stated to have called a care staff to assist the resident. S2 corroborated S1’s statement. S3 denied the observation of medications being left unattended and accessible to residents.

On 10/17/2024, LPA Dolores and LPA Fortes toured the facility to include the first and second floor. Based on observation, LPAs did not observe medications that were left accessible to residents in care. LPAs observed the medication cart located on the second floor was locked.

The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unfounded meaning the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Executive Director, Kenia Sanchez and a copy of the report was provided.

Page 2 of 2.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2