435202898-10-8-2024-26-AS-KHOS-DABSAC-20241023134206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202898
Report Date: 10/08/2024
Date Signed: 10/08/2024 03:54:37 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 Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20241007112136

FACILITY NAME:	OAKMONT OF SILVER CREEK		FACILITY NUMBER:	435202898
ADMINISTRATOR:	DIAL, JAMES		FACILITY TYPE:	740
ADDRESS:	3544 SAN FELIPE ROAD		TELEPHONE:	(669) 200-2443
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	148	CENSUS: 82	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Holly Suiter		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff do not follow infection control protocols.
Staff do not assist residents with care needs in a timely manner.
Staff do not ensure medications are inaccessible to residents.
Staff do not maintain complete records for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced visit to deliver findings regarding the allegation listed above LPA met with Administrator Holly Suiter.

On October 7, 2024, the Department received a complaint alleging staff do not follow infection control protocols. It has been alleged staff wearing gloves touching everything.

On August 7, 2024, LPA interviewed residents R1-R7. 3 Out of 7 residents (R1,R4,R6) interviewed stated they did not want to be interviewed. 2 Out of 7 residents interviewed (R2 & R5) stated staff wear gloves and throw them away after using them. 2 Out of 7 residents interviewed (R3 & R7) stated they don't know what the staff do regarding their gloves.

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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 4

Control Number 26-AS-20241007112136

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 SILVER CREEK	FACILITY NUMBER: 435202898
	VISIT DATE: 10/08/2024

NARRATIVE

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LPA interviewed staff S1-S6. 6 Out of 6 staff interviewed stated staff use gloves to assist residents with bathing, showering, toileting and other ADLs. 6 Out of 6 staff interviewed stated when the gloves become stained from use, then staff will dispose of them and get a clean pair.

LPA interviewed ADM. ADM stated the facility has plenty of supplies regarding gloves. ADM stated once they have completed their tasks regarding a residents, the gloves should be tossed.

During the visit, LPA observed facility staff wearing gloves to assist residents. Once staff finished assisting residents with ADL's or cleaning, staff tossed the used gloves.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Staff do not assist residents with care needs in a timely manner.

On October 7, 2024, the Department received a complaint alleging Staff do not assist residents with care needs in a timely manner.

On August 7, 2024, LPA interviewed residents R1-R7. 3 Out of 7 residents (R1,R4,R6) interviewed stated they did not want to be interviewed. 1 Out of 7 residents interviewed (R3) stated he/she does not know if staff assist residents in a timely manner. 3 Out of 7 residents interviewed (R2, R5,R7) stated when residents ask for help, staff assist them and don't keep them waiting or delay.

LPA interviewed staff S1-S6. 6 Out of 6 staff interviewed stated staff assist residents in a timely manner. 6 Out of 6 staff interviewed stated staff do not delay in assisting residents with their care needs and have not observed any delay.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20241007112136

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 SILVER CREEK	FACILITY NUMBER: 435202898
	VISIT DATE: 10/08/2024

NARRATIVE

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LPA interviewed ADM. ADM stated staff provide assistance to residents when requested. ADM stated there has not been any delay to providing care to residents. ADM stated the AM/PM staffing is as follows: 1 medtech 2-3 care staff. 1 activity director, 1 memory care director. ADM stated the night shift has one medtech for memory care and one for assisted living. ADM stated there are 2 care staff in memory care and 1 for assisted living.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Staff do not ensure medications are inaccessible to residents.
On October 7, 2024, the Department received a complaint alleging Staff do not ensure medications are inaccessible to residents.

On August 7, 2024, LPA interviewed residents R1-R7. 3 Out of 7 residents (R1,R4,R6) interviewed stated they did not want to be interviewed. 3 Out of 7 residents interviewed (R2, R3, R5,R7) stated they have not observed residents medications accessible to residents.

LPA interviewed staff S1-S6. 6 Out of 6 staff they have not observed residents medications accessible to residents in care. 6 Out of 6 staff stated residents medications are secured in the medication room, which residents do not have access to.

LPA toured the memory care unit inside and out and did not observe any medications accessible to residents in care. LPA observed during tour of the memory care unit's medication room. LPA observed the medication room was locked and inaccessible to residents in care.

LPA interviewed ADM. ADM stated, she has not seen any residents medications accessible to residents in care.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.Page 3 Out of 4

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20241007112136

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 SILVER CREEK	FACILITY NUMBER: 435202898
	VISIT DATE: 10/08/2024

NARRATIVE

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Staff do not maintain complete records for residents.

On October 7, 2024, the Department received a complaint alleging Staff do not maintain complete records for residents. It has been alleged the facility does not complete any incontinence log.

LPA interviewed staff S1-S6. 5 Out of 6 staff interviewed stated staff complete a Bowel Movement log for residents with incontinence and those with doctors orders.

LPA interviewed ADM. ADM stated the facility does have charts for ADL's and a bowel Movement log. ADM stated the memory care unit has 19 Out of 21 residents in memory care with incontinence.

LPA requested to randomly review 3 residents ADL charts/ BM log. LPA observed the logs to be filled out and complete.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Page 4 Out of 4. END OF REPORT.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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