435202898-6-4-2025-26-AS-MPAA-DHL3NW-20250612182436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202898
Report Date: 06/04/2025
Date Signed: 06/04/2025 02:29:52 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
04/23/2025 and conducted by Evaluator Marcela Yanez

COMPLAINT CONTROL NUMBER: 26-AS-20250423070752

FACILITY NAME:	OAKMONT OF SILVER CREEK		FACILITY NUMBER:	435202898
ADMINISTRATOR:	HOLLY SUITER		FACILITY TYPE:	740
ADDRESS:	3544 SAN FELIPE ROAD		TELEPHONE:	(669) 200-2443
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	148	CENSUS: 66	DATE:	06/04/2025
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Mary Ann Bangsal, Business Office Director		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff are neglecting resident resulting in falls
Facility is short staffed resulting in lack of supervision
Facility staff are not cleaning residents room
Facility staff are not administering medication in a timely manner
Facility staff are not assisting residents during meal time
Staff are not repositioning the resident every hour

INVESTIGATION FINDINGS:

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On 06/04/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced visit to deliver the complaint investigation findings. LPA announced the purpose of the visit and met with Mary Ann Bangsal, Business office director.

On 04/23/25 the department received a complaint with the above allegations.

On 04/30/25 LPA conducted an initial investigation visit and met with Exuctive Director Holly Suiter.

During visit LPA requested 5 residents records, facility housekeeping log, interviewed 10 Staff (S1-S10), and 10 Resident (R1-R10). LPA toured the facility and inspected 7 resident rooms both in the memory and assisted living area of the facility.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250423070752

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: 06/04/2025

NARRATIVE

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LPA observed 7 out of 7 resident room to be organized and sanitary. LPA interviewed ED who provided the schedule for housekeeping and stated that the resident’s bedrooms are audited daily. ED stated that facility maintains a daily housekeeping log of resident’s room that requires cleaning, and staff will add it to the housekeeping log if needed. LPA observed 4 staff assisting residents in the dining area and 2 staff cleaning rooms.

LPA interviewed Staff (S1-S10) 8 out of 10 staff stated that the facility had daily log of rooms that needs cleaning. 3 out 10 staff stated housekeeping does audits of resident rooms to check if they need to be cleaned and if they are not on list staff will still clean the resident’s room. 1 out of 10 staff stated that 1 resident had an accident in the bathroom, and it was cleaned and disinfected in a timely manner.

10 out of 10 staff stated that the residents normally eat in the dining area and only eat in their rooms if they are ill. 8 Out of 10 staff stated that the facility staff encourages to eat and assist them with feeding when staff notices the resident has not touched their food and needs assistance in Memory Care.

2 out of 10 staff stated that the resident’s medication is given to them on time. 3 out of 10 staff states that sometimes residents do not want to wake up early and medication and are given to residents when they wake up.

LPA interviewed 10 residents (R1-R10). 2 out of 10 residents stated they have not fallen. 2 out of 10 residents stated that their rooms are always clean, and the staff are attentive to their needs. 2 out of 10 residents stated that their bathrooms are always clean and have not seen any type of smearing on the walls.

LPA reviewed 4 resident record and was able to verify that medications are administered to residents based on doctor’s order and administered to them in a timely manner. LPA was present at the facility during the medication pass and observed the medications were given on time.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250423070752

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: 06/04/2025

NARRATIVE

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On 06/04/25 LPA interviewed Luisa Lopez Health Services Director and verified that R1 does not have a doctors order for repositioning every hour.

Based on observation, interviews and document reviews, the Department has completed its investigation and found that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation did or did not occur, therefore the above allegations are unsubstantiated.

No deficiencies are being cited during today’s visit based on California Code of Regulations Title 22. An exit interview was conducted with Business Office Director Mary Ann Bangal and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

LIC9099 (FAS) - (06/04)

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