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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202898
Report Date: 12/16/2024
Date Signed: 12/16/2024 03:54:37 PM

Document Has Been Signed on 12/16/2024 03:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 SILVER CREEKFACILITY NUMBER:
435202898
ADMINISTRATOR/
DIRECTOR:		HOLLY SUITERFACILITY TYPE:
740
ADDRESS:3544 SAN FELIPE ROADTELEPHONE:
(669) 200-2443
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 148CENSUS: 74DATE:
12/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Holly Suiter - Executive Director/AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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
Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver the results of a complaint investigation. During the complaint investigation for the complaint 26-AS-20240315163012, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met Holly Suiter - Executive Director/Administrator.

On November 21, 2024, LPA Monter interviewed staff S5-S10. All staff interviewed stated R1 has the behavior of trying to enter other residents’ bedrooms. S5 & S8 stated since R1 moved into the facility, he/she has had the behavior of attempting to enter residents’ bedrooms. S5 - S10 stated staff are supposed to redirect R1 if he/she is trying to enter another resident’s bedroom. S5 – S10 stated staff are supposed to lock resident bedroom doors to prevent other residents from entering their bedrooms.

LPA observed a resident attempting to enter his/her bedroom but was unable to unlock the door. LPA was interviewing Staff S5 in the hallway when this happened. Staff S5 had already clocked out and when he/she went to ask for a staff members assistance to help the resident enter her bedroom. Staff S9 was brought by staff S5 and unlocked the bedroom for the resident. LPA observed the staff locking bedroom doors and unlocking residents bedroom doors when residents wanted to enter.

On November 27, 2024, LPA Monter interview staff S2-S3. S2 & S3 stated R1 has the behavior of entering other residents’ bedrooms. S2 and S3 stated staff are supposed to lock residents bedroom doors.

Page 1 Out of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 SILVER CREEK
FACILITY NUMBER: 435202898
VISIT DATE: 12/16/2024
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
On December 13, 2024, LPA Monter interviewed staff S11. S11 stated due to R1’s behavior of entering other residents’ bedrooms, that was the reason why the staff keeps the resident bedrooms locked. S11 stated R1 attempts to enter other residents’ bedrooms at least Once day at least. S11 stated Once resident is taken to dining area, staff locks resident bedroom. S11 stated staff has been doing this since he/she has been working at the facility.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Holly Suiter - Executive Director/Administrator. A copy of the report was provided. Appeal rights were provided.

Page 2 Out of 2. END OF REPORT.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 12/16/2024 03:54 PM - It Cannot Be Edited


Created By: Manuel Monter On 12/16/2024 at 02:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: OAKMONT OF SILVER CREEK
FACILITY NUMBER: 435202898

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
12/17/2024
Section Cited
CCR
87468.1(a)(2)

1
2
3
4
5
6
7
 87468.1 Personal Rights of Residents in all Facilities (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement was not met as evidenced by;
1
2
3
4
5
6
7
ADM stated she will send a written plan of action on how the facility will ensure comfortable accomodations and ensuring residents personal rights, when addressing residents who enter other residents bedrooms.
8
9
10
11
12
13
14
Based on observation and interviews conducted, facility staff is locking resident’s bedroom doors, requiring residents to ask staff for assistance in opening their bedroom door. This poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
ADM stated she will send a written letter of understanding regarding the regulation.

ADM stated she will send the written plan of action by POC date, 12/17/24

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.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Manuel Monter
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3