<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202874
Report Date: 12/30/2025
Date Signed: 12/30/2025 01:34:13 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
09/23/2024 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20240923130821
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: DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Karen Nickolai, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained multiple falls while in care due to lack of staff supervision
Resident sustained multiple injuries while in care
Facility is not kept free of pests
Staff are not following resident's care plan
Staff prevented resident in care from leaving facility common area
Resident in care was not allowed to participate in activities
Staff did not provide proper cleaning services to resident in care
Staff did not ensure hot water was made available to residents in care
Staff did not prevent residents from stealing other resident's personal items
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/30/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver findings. LPA announced the purpose of the visit and met with Karen Nickolai, Administrator
On 09/23/24 the department recieved a complaint with the above allegations
On 09/26/24 LPA Kabarati conducted an initial complaint investigation visit and obtained pertinent documents.

It was alleged that the facility did not prevent resident from falling on several occasions. Based on documentation 06/21/2024: No fall is noted. The fall nearest to the date of 06/21/2024 occurred on 06/18/2024. The fall was recorded/captured by the Safely You technology located in each of the residents room in the facility. R1 fell and hit his/her head and no injuries were noted and R1 denied any pain or discomfort.
page 1 of 9
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
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 16
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
09/23/2024 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20240923130821

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: DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:TIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident was provided clean clothing
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/30/25 Licesning Program Analyst (LPA) Marcela Yanez conducted an unnanounced complaint investigation visit to deliver findings. LPA anounnced the purpose of the visit and met with Karen Nickolai, Administrator.

On 09/23/24 the department recieved a complaint with the above allegations

On 09/26/24 LPA Kabarati conducted an initial complaint investigation visit and obtained pertinent documents.

It was alleged that when R1’s responsible party visits R1 every night, R1 is observed disheveled in dirty clothing.

page 1
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
page 2
On 10/08/2025, staff S1 was interviewed. Based on interview, S1 stated that R1 had to wear dirty clothing because they were short staffed and the caregivers didn’t have enough time to get through all the laundry. S1 states that sometimes they couldn’t get through all the laundry, and all the residents’ dirty clothes would pile up. S1 stated that the caregivers tried their best but sometimes it wasn’t enough time to complete the laundry.

On 10/08/2025, staff S2 was interviewed. Based on interview, S2 denied observing R1 wear dirty clothes. S2 stated that there were times when the resident’s dirty laundry piled up and knew it was an issue. S2 could not specifically recall R1’s laundry but stated that R1’s clothes were always changed if he/she got them dirty after a meal.

Based on a photograph dated 09/20/2024. RP provided of R1’s clothing, it’s observed that R1’s black t-shirt contained white spots throughout his/her shirt and larger white spots on the left side of the chest area resembling food or drink droppings. R1’s black shorts also contained white spots throughout his/her shorts and larger spots on the left side on his/her upper thigh area resembling food or drink droppings. RP provided a second photo dated 09/22/24 that showed R1 to have food or drink droppings on the left side of black shirt and food or drink droppings on left side of black leggings.

The Department has investigated the above allegations. Based on interview and observation the preponderance of evidence standard has been met; therefore, the above allegations are substantiated.

Deficiency is cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Karen Nickolai, and a copy of the report and appeals rights was provided.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 16
Control Number 26-AS-20240923130821
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2026
Section Cited
CCR
87464(f)(4)
1
2
3
4
5
6
7
87464(f)(4) Basic services shall at a minimum include:(4)Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal... activities of daily living such as dressing, eating, bathing and assistance...
this requirement was not met as evidenced by:
1
2
3
4
5
6
7
Administrator stated she will provide a letter of understanding of regulation and has hired more staff. ADM will submit to LPA Yanez by POC due date 01/09/25 via email.
8
9
10
11
12
13
14
Based on interview and photo,
S1, S2 stated the facility was short staffed and the R1s laundry did not get washed. S1 stated R1 had to wear dirty clothing. RP provided photo R1 had soiled clothing on two seperate occasions 09/20/24, and 09/22/24. This posed a potential risk to the health and safety of residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
page 2
“THIS REPORT WAS AMENDED. THE REPORT WAS INADVERTENTLY ATTACHED TO THE SUBSTANTIATED COMPLAINT FINDING. THE CONTENTS OF THIS PAGE BELONGS TO THE LIC9099-A FOR THE UNFOUNDED COMPLAINT ALLEGING “STAFF MISMANAGED RESIDENT’S MEDICATION. SEE LIC9099-A UNFOUNDED REPORT FOR MORE INFORMATION.”


Based on record review, R1 was under hospice care. The medication (M1) was prescribed by the hospice care physician which the physician’s order instructions (dated 08/07/2024) stated “Administer … every 4 hours as needed for pain ….”.

On 08/07/24 per facility observation R1 was prescribed a medication that was not in ALIS and RP was informed regarding medication not being administered due to not being in the system. RP gave the medication to R1. Per documentation all medication was given as directed by doctors orders.

On 12/30/25 the department concluded its investigation.

We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiency is cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Karen Nickolai, Administrator and a copy of the report was provided.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 16
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
09/23/2024 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20240923130821

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: 37DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Karen Nickolai, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mismanaged resident's medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/30/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver findings. LPA announced the purpose of the visit and met Karen Nickolai, Administrator

On 09/23/24 the department recieved a complaint with the above allegations

On 09/26/24 LPA Kabarati conducted an initial complaint investigation visit and obtained pertinent documents.

It was alleged that staff mismanaged resident (R1)’s medication. Based on the reporting party, it was stated that staff were giving medication (M1) to R1 every four hours because R1 was on his/her “last days”. When M1 was stopped, R1’s abilities improved.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 10 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 2
“THIS REPORT WAS AMENDED TO REMOVE THE LINE “ALLEGING THAT THE FACILITY IS CHARGING SERVICES NOT AGREED ON THE ADMISSION AGREEMENT” AS THIS WAS INADVERTENTLY INCLUDED IN THE REPORT

Based on record review, R1 was under hospice care. The medication (M1) was prescribed by the hospice care physician which the physician’s order instructions (dated 08/07/2024) stated “Administer … every 4 hours as needed for pain ….”.

On 08/07/24 per facility observation R1 was prescribed a medication that was not in ALIS and RP was informed regarding medication not being administered due to not being in the system. RP gave the medication to R1.

This department has investigated the complaint. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiency is cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Karen Nickolai, and a copy of the report was provided.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 11 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 2

On 07/16/2024 R1 had an unwitnessed fall and in the hallway R1 was walking and lost his/her balance resident returned to community with no injuries. On 07/17/2024 R1 fell the fall was recorded/captured by the Safely You technology and RP denied any pain or discomfort and no injuries were noted.

On 08/05/24 R1 was observed laying on his/her back on the bathroom floor when asked R1 stated he/she had fell. R1 complained of back and head pain. R1 was sent to the hospital for follow up and was given an appointment for follow up with neurosurgery. On 08/06/2024, R1 was discharged back to the facility with a final diagnosis listed a brain bleed. On 09/12/24 the facility observations stated resident was a fall risk.

ED was asked if a resident sustaining over 22 falls was normal and ED stated that approximately two to four weeks prior to R1 being moved out of the facility, facility staff “suggested” to R1s family that the facility could no longer provide care for R1. Facility staff suggested that R1 have one-on-one supervision, be placed in a different setting, or have his/her medications changed. RP initiated R1s moving out of the facility because ED “asked RP to provide one on one.”

At the time that R1 lived in the facility, the facility was not understaffed. There were only 25 residents in the facility when R1 lived in the facility. R1s care plan stated staff were scheduled to do wellness checks every 3 hours to check for safety and any needs as well as to see if resident is asleep and or having any needs. R1 was also on bowel monitoring 3 times a day.

R1 moved into the facility on 05/25/24. R1 fell on 05/28/24 R1 had a witnessed fall in the activity room, no injury noted and denied pain and discomfort. On 05/31/24 R1 had restlessness and agitation R1 repeatedly looking for exit seeking behavior facility staff redirected the resident away from all exit doors. R1 was noted to be awake and confused and refused to go inside his/her room, it was noted for noc shift to do frequent checks.

It was alleged Resident sustained multiple injuries while in care.

On 06/18/24 R1 was standing by the refrigerator and had a fall and lost his/her balance and hit his/her head no injuries noted

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 3
On 06/18/24 facility staff Director of Nursing published a care plan and updated environmental and lighting for R1 and staff training on placement of assisted devices and to remind R1 to use assistive devices. Care plan was also updated on provided accompanied walks for resident for daily shifts. Based on record review the resident had a record of unsteady gate, history of witnessed and unwitnessed falls.

RP submitted photo dated 06/25/24 which showed a bruise on left hip, left elbow and another bruise on left shoulder blade.

On 07/16/24 resident had a fall and went to the hospital and suffered a hip contusion, head injury and cervical strain.

On 07/17/24 R1 was noted for fall risk and under monitoring on facility observations.

RP submitted photo dated 09/20/24 with a small scratch on R1s left side of eye under eyebrow about 1 inch in length

Based on record review and interview R1 was reminded to use walker to ambulate and or use a 4 point cane. R1 was also monitored by staff and reminded to stop during walks when he/she felt weak or unstable.

It was alleged that the facility is not kept free of pests as the reporting party reported observations of ants seen in R1’s bathroom, refrigerator and linens. Based on 2 staff interviews, it was stated that the facility has problems with ants in the community. Both staff stated that when they observe ants, they are treated with ant spray.



The Executive Director stated that the facility has pest control services which serve the entire facility once a month and conducts routine services. The executive director stated to be unsure if there were any ant problems inside R1’s bedroom.

On 05/21/2025, LPA Kabariti conducted an unannounced visit and entered rooms #232, 234, 236, 238, 237, 233, 229, 202, 201, 207, and 213. LPA Kabariti did not observe ants inside the resident bedrooms.

On 10/08/2025, LPA Kabariti conducted another unannounced visit and entered rooms 207, 233, 234, and 211. LPA Kabariti did not observe any ants inside the residents’ bedrooms.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 12 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 3

It was alleged that the facility is not following R1’s care plan as the staff began to miss the resident’s shower days, which was scheduled for Monday and Fridays. The reporting party (RP) stated that he/she typically visits R1 every evening, however, missed four days of visits due to health issues.

Per care plan RP states that R1 was under hospice, and hospice began bathing R1 but was never consistent. RP stated that per the granny cam that RP installed inside R1’s bedroom, it showed staff taking R1 to the restroom and immediately taking R1 to breakfast. RP stated that once Hospice services were initiated the facility did not provide any showers to R1. RP stated that Hospice caregiver would give showers to R1 3 times a week and the other 2 days were supposed to be given by Facility Staff. RP stated he/she volunteered to give R1 showers when he/she visited.

RP stated that the videos from granny cam of facility not providing care to R1 were deleted by spouse. RP did mention that other residents were observed in the videos eating residents food and frequently entering and exiting R1s room but was unable to provide videos because they were deleted.

On 05/21/2025, the Executive Director (ED) was interviewed. Based on interview, the ED stated that R1’s shower days were typically twice a week unless it’s requested by responsible party to have R1 shower more or less days. The ED denied R1 missing his/her shower days and did not remember if R1 refused any showers.

On 10/08/2025, staff (S1) was interviewed. Based on interview, S1 stated that there were times in the morning when they were short staffed and were not able to give all the resident showers but knew that each staff tried to help each other out. S1 could not recall the exact dates, whether R1 ever missed his/her shower days when they were short staffed, and did not recall R1 refusing any showers.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 13 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
page 4

On 10/08/2025, staff (S2) was interviewed. Based on interview, S2 stated that R1’s showers were 2-3 times a week in the morning time. S2 stated to have assisted R1 with showers once and did not recall any issues when showering R1.

S2 stated they all worked together to get all the residents showered. If the staff didn’t have time in the AM, they always communicated to the PM shift and PM shift helped. S2 denied any residents missing their shower schedule days, to include R1. R1s care plan showed R1s scheduled days to shower was Monday and Fridays in the morning. RP stated that the Hospice caregiver was supposed to shower R1 3 times a week and facility staff were supposed to shower R1 2 times a week.

Based on record review, the facility does not have any record logging the completion of resident’s showers. RP stated that Suncrest hospice services was not providing showers to resident and switched to Redwood Hospice services due to the lack of care Suncrest hospice care was providing.

RP stated that R1 was to receive 3 showers a week and in the interim the facility staff was to give R1 a shower on days the hospice caregiver did not provide showers. RP stated R1 did not receive showers on the other 2 days of the week.

RP stated he/she would give showers during his/her visit. S1 stated that the facility was short staffed and sometimes R1 did not receive a shower from facility staff.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 14 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 5
It was alleged that the facility staff blocks the common area with a wooden round table so R1 cannot leave on his/her wheelchair.

On 09/29/2025, the Executive Director (ED) was interviewed. Based on interview, the ED denied observing R1 blocked by the wooden round table and unable to leave his/her wheelchair.

On 10/08/2025, staff (S1) was interviewed. Based on interview, S1 stated that R1 needed 1:1 care and would normally have a caregiver sit with R1 in the common area. S1 stated one time where he/she saw R1 sitting on his/her wheelchair in front of a table with the wall behind R1, so R1 couldn’t stand up. S1 stated that R1 was in the wheelchair all the time but R1 always tried to stand up. S1 stated that R1 had a lot of falls.

S1 stated the staff positioned R1 in between the wall and table to prevent R1 from falling and for safety reasons. S1 states that the Executive Director (at the time) knew about it and stated it was for safety. S1 states that because the ED knew about it and didn’t say anything, S1 just followed.

On 10/08/2025, staff (S2) was interviewed. Based on interviews, S2 stated that when R1 participated in activities, staff would always sit with R1 for safety reasons because R1 was a fall risk. S2 stated that R1 would be placed in a position where R1 can move freely. S2 denied the observation of R1’s movement being restricted from being placed in between the wall and table. S2 stated that if the staff ever had challenges with R1, they would always help each other.

On 05/21/2025, 5 staff were interviewed who all denied observing staff to prevent a resident from leaving the common area. Staff stated that residents can wander throughout the hallway with staff supervision.

On 05/21/2025 and 10/08/2025, LPA Kabariti conducted an unannounced visit and did not observe any residents who were blocked in the common area with a wooden round table. LPA Kabariti observed residents participating in activities in the common area and some residents were observed walking through the hallways.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 6

It was alleged that the staff do not allow the resident to participate in activities. Based on the reporting party (RP), it was stated that R1 is left in the common area to watch TV with other residents for hours at a time. RP stated that R1 is not allowed to participate in activities because R1 is unable to walk/stand.

On 09/29/2025, the Executive Director (ED) was interviewed. Based on interviews, the ED stated that R1 was always allowed to participate in activities. ED stated that R1 was always in the common areas because the staff needed to keep a close eye on R1 due being a fall risk. ED stated that R1 would participate in activities when they put sensory items on the table in the activity room. On 09/29/2025, 5 staff were interviewed who all stated that all residents can participate in activities.

On 10/08/2025, staff (S1) was interviewed. Based on interviews, S1 stated that R1 participates in all activities. S1 stated that R1 is normally in the common area with his/her 1:1 staff participating in activities.

On 10/08/2025, staff (S2) was interviewed. Based on interviews, S2 stated that R1 always participated in activities. S2 stated that R1 participated in arts and crafts, music, and the performances.

It was alleged that the staff did not provide proper cleaning services to residents in care. Based on the reporting party (RP), it was stated that R1’s bedroom had not been clean the entire time R1 has been at the facility until R1’s responsible party had complained in August 2024. It was stated that the next day, the Executive Director had R1’s room cleaned. It was stated that since the first cleaning in August, the room had been vacuumed one more time in September 2024, the toilet and shower have only been cleaned twice, and the trash inside R1’s bedroom was not taken out nightly.

RP was unable to provide any photographs of room that not being cleaned and or garbage not being removed and full.

During a local law enforcement welfare check on R1 on 09/26/2024, it was noted that R1’s room was observed clean.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 7

On 05/21/2025, the Executive Director was interviewed. Based on interview, the ED stated that full housekeeping is completed once a week which they consider as the “deep clean” which entails beddings, deep clean the restroom, entire room, refrigerator, and counter. The ED stated that the trash is taken out daily and throughout the shift.

On 05/21/2025, 5 staff members were interviewed. It was stated that housekeeping is completed daily and the caregivers help with to maintain the cleanliness of the bedrooms. Staff stated that the residents’ trash are taken out in the morning.

On 10/08/2025, staff (S1) was interviewed. Based on interview, S1 stated that because of the short staff at the time of R1’s stay at the facility the rooms were not cleaned well. It was stated that the caregivers were supposed to throw out the trash every shift or when the resident’s trash bin was full but there were times when the trash was full because they were short staffed. It was stated that they did have housekeeping staff but when the housekeepers were off, it would be the caregiver’s responsibility to maintain the resident rooms.

On 10/08/2025, staff (S2) was interviewed. Based on interview, S2 stated that there were times when the residents’ trash bins did accumulate and were full. S2 stated to think the trash wasn’t taken out timely because the caregivers would forget or would be too busy.

On 05/21/2025, LPA Kabariti conducted an unannounced visit and randomly entered 11 resident bedrooms between the time 09:30AM – 10:30AM. 1 out of 11 resident bedrooms had a full trash bin but the room was observed well maintained. The ED stated that the staff may still not be done taking out the trash. All remainder of the resident bedrooms that were randomly entered were observed well maintained.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 8
On 10/08/2025, LPA Kabariti conducted another unannounced visit and randomly entered 6 resident bedrooms. LPA Kabariti observed that 1 out of 6 resident bedrooms was not well maintained. LPA observed tissue paper scattered through the floor and brown spots throughout the carpeted floor and wood floor, a foul order in the resident’s bedroom, and a body wash bottle that contained a brown substance smeared at the top of the bottle. The Executive Director immediately called the housekeeper for assistance to clean the resident’s bedroom

It was alleged that the facility did not have hot water available for residents for two days.
On 05/21/2025, the Executive Director (ED) was interviewed. Based on interview, ED stated that there was a time when there was issue with R1’s hot water. S1 states the hot water was fixed immediately and the issue only lasted a couple days.

ED states the facility has issues with the hot water temperature and was reported to her on 05/19/2025. ED states they have a quote to repair on the issue. ED states in the meantime, they are utilizing empty apartments with hot water for showers.

On 10/08/2025, staff (S1) was interviewed. Based on staff interview, it was stated that some rooms did not have hot water, and it was months until some of the rooms hot water was fixed. S1 states that when they didn’t have hot water, the staff would borrow the empty rooms to shower the residents.

S2 stated issues with some of the residents’ hot water not working in their bedrooms. S2 stated that if a resident’s hot water wasn’t working, they’ll warm up water and give the resident a bed bath, or a sponge bath, or take the resident to another room with working hot water.

It was alleged the staff did not prevent residents from stealing other residents personal items. On 10/08/25 S8 stated all the rooms had a code to get into the rooms because there were concerns that some of the residents would go into other residents’ rooms. Since he/she started working there, all the bedrooms were always locked from the outside where they required a code to get in.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 15 of 16
Control Number 26-AS-20240923130821
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: 12/30/2025
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
Page 9

3 out of 6 staff stated he/she observed residents wandering into other residents’ rooms, he/she would help guide them in another direction. If he/she observes items that were accidentally misplaced, he/she take it back to whoever they belonged to. 3 out of 6 staff stated if they would see a resident stealing something he/she would make sure to redirect the resident verbally. Then the staff would take the items back to the resident room.

On 12/30/25 the department has concluded its investigation.

Based on documents reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur.

No deficiency is cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Karen Nickolai, and a copy of the report was provided.

End of Report
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 16 of 16