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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202874
Report Date: 07/08/2025
Date Signed: 07/08/2025 05:11:53 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
10/24/2024 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20241024102358
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: 24DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Krystal Jenkins, Regional Operations Specialist TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility did not ensure sufficient number of staff at all times to provide the services necessary to meet the resident's needs.
Staff are not trained in assisting residents with medication.
INVESTIGATION FINDINGS:
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On 10/24/2024 the Department received a complaint with the above allegations. On 10/31/2024 LPAs conducted the initial 10-day investigation.

On 10/31/2024 LPAs interviewed 2 staff. 2 Out of 2 Staff state the facility has enough staff to provide the services necessary to meet resident’s needs.

On 7/8/2025 LPAs interviewed 4 staff. 4 out of 4 staff state the facility has enough staff to meet residents’ needs. Health Services Director (HSD) states the facility has enough staff to meet residents' needs.

On 7/8/2025, LPAs interviewed 7 Residents. 4 Out of 7 Residents stated the facility has enough staff to provide the services necessary to meet the residents’ needs. 3 Out of 7 residents were unable to provide an answer to LPAs questions.
Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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 2
Control Number 26-AS-20241024102358
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: 07/08/2025
NARRATIVE
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On 10/31/2024 LPAs interviewed 2 Staff. 2 Out of 2 Staff stated he/she has received training in medication administration.

On 7/8/2025, LPAs interviewed 4 staff. 3 Out of 4 staff stated he/she does not assist residents with medications, as he/she is not a med-tech. S3 states he/she has received training in assisting residents with medications.

LPAs reviewed 4 med-tech staff training records. Based on review, 4 Out of 4 med-techs have completed training.

LPAs interviewed 7 Residents. 4 out of 7 Residents stated he/she receives assistance with medications. 3 Residents were unable to provide an answer to LPAs questions.

Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
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