435202937-2-20-2026-26-AS-RMAO-DS4QR3-20260312122312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202937
Report Date: 02/20/2026
Date Signed: 02/20/2026 04:59:32 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
07/07/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250707122429

FACILITY NAME:	WATERMARK AT SAN JOSE, THE		FACILITY NUMBER:	435202937
ADMINISTRATOR:	KELLIE SHEARER		FACILITY TYPE:	740
ADDRESS:	1017 S BASCOM AVE		TELEPHONE:	(520) 797-4000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	205	CENSUS:	DATE:	02/20/2026
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Human Resurce Director (HRD) Carolina Villar-Mata		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not properly maintain a resident's room
Staff do not meet a resident's hygiene needs and laundry needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Human Resurce Director (HRD) Carolina Villar-Mata

On July 7, 2025 the Department received a complaint alleging Staff do not properly maintain a resident's room.

On July 14, 2025, Licensing Program Analyst Steve Chang interviewed residents R1- R7. R1 stated facility staff never clean his/her room. 1 Out of 7 residents (R2) interviewed were unable to provide any relevant information due to neurocognitive disorder. 1 Out of 7 residents (R3) stated he/she does not remember how often staff clean his/her room. 4 Out of 7 Residents interviewed (R4-R7) stated the facility staff clean his/her room once a week.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

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 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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On July 14, 2025, LPA Chang interviewed residents R1-R5. R1 stated facility staff never clean his/her room. 2 Out of 7 residents (R2 & R3) stated they don’t know how often the staff clean their room. 4 Out of 7 residents (R4-R7) stated facility staff clean their room once a week.

On July 14, 2025, LPA Steve Chang interviewed Administrator (ADM) Kellie Shearer. ADM stated housekeepers clean residents room once per week. ADM stated caregivers take out trash when caregivers visit resident rooms. ADM stated the facility has scheduled laundry and scheduled cleaning room for resident.
On July 14, 2025, LPA Steve Chang toured the following bedrooms: 205, 221A, 254, 422, 448, 434, 516, 527, 552, 553. LPA observed the bedrooms in a sanitary condition, with no trash on the floor or tables.

On October 3, 2025, LPA Chang interviewed residents R8-R13. 6 Out of 6 residents interviewed (R8-R13), stated facility staff clean their bedroom once a week.

On January 20, 2026, LPA Monter interviewed witness W1. W1 stated R1’s bedroom is filthy. W1 stated he/she could tell staff are not dusting. W1 stated he/she cleans R1’s bedroom him/herself.

On January 23, 2026, LPA Manuel Monter interviewed residents R14-R18. 4 Out of 5 residents (R14-R17) stated their room is cleaned every day. 4 Out of 5 residents (R14-R17) stated they have not had any issues with the cleanliness of his/her room. R18 was unable to provide any relevant information due to neurocognitive disorder.

On January 23, 2026, LPA Manuel Monter toured the memory care unit inside and out. LPA toured the following bedrooms: 234, 236, 238, 240 A+B, 242, 244, 246, 247, 249, 248, 250, 253, 252, 254, 257, 256, 259 A+B, 258, 222, 221 A+B, 218, 220, 216 A+B, 214, 212, 210, 209, 208, 207, 205, 206, 203, 200 A+B, 201 A+B. During the tour of the memory care unit, LPA did not observe any areas as unclean, unhygienic or disorderly.

On January 23, 2026, LPA Monter interviewed staff S2-S6. 5 Out of 5 Staff (S2-S6) stated housekeeping cleans residents bedrooms and care staff will spot clean the bedroom as well. 5 Out of 5 Staff (S2-S6) stated they are not aware or have never seen a residents bedroom as dirty or neglected.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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On January 23, 2026, LPA Monter interviewed Assisted Living Director (ALD), Mayte Calderon. ALD stated the housekeeping cleans the residents’ bedrooms. ALD stated the care staff will spot clean a resident bedroom. ALD stated if a resident has an accident, then care staff will clean it and housekeeping will do a deep clean. ALD stated she is not aware and or has never seen a resident bedroom as dirty or neglected.

On February 5, 2026, LPA Manuel Monter interviewed Maintenance Director (MD) Mithun Prasad. MD stated general cleaning of the residents bedrooms are divided up between the care givers and housekeeping. MD stated the care givers do general everyday pick up and housekeeping will do the more in-depth cleaning. MD stated the cleaning of the residents bedrooms are done via schedule. MD stated he will go at least once a week and do random checks on the rooms. MD stated during his time working at the facility, he hasn’t observed any issues regarding cleanliness.

LPA Monter interviewed Health & Wellness Director (HW) Baneen. HW stated she has not seen any resident bedroom that was not clean or neglected. HW stated residents bedrooms are cleaned.

LPA Monter interviewed Memory Care Director MCD, Daleht Miranda. MCD stated he/she has not seen any residents bedrooms that were not clean or were neglected.

On February 11, 2026, LPA Manuel Monter interviewed residents R19-R22. 4 Out of 4 residents interviewed (R19-R22) stated they bedrooms are cleaned weekly and have not had any issues with their bedrooms not being cleaned.

On February 5, 11 & 17, 2026, Licensing Program Analyst Manuel Monter interviewed Staff S7-S12. 4 Out of 6 staff (S7, S10, S11) stated they have not seen any resident bedroom that were not clean or were neglected. S8 stated, some time in June-August 2025, there was instances when residents rooms were not cleaned timely, due to staffing issues. S8 stated the facility did have troubling but doesn’t recall any specific incidents but stated it occurred in June-August 2025. Staff S9 stated he/she has seen bedrooms that were not cleaned by other shifts. S9 stated this occurred months ago, but cannot recall details on where or when this occurred.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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Based on investigation, records 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 allegations did or did not occur.

Staff do not meet a resident's hygiene needs and laundry needs.

On July 7, 2025 the Department received a complaint alleging Staff do not meet a resident's hygiene needs and laundry needs. It has been alleged R1’s laundry needs and showering needs were not being met.

On July 14, 2025, Licensing Program Analyst Steve Chang interviewed residents R1-R7. R1 stated the facility staff never do the laundry for him/her. R1 stated the facility staff never showered him/her. R2 stated he/she does not remember how often the facility does his/her laundry and how often he/she has showers. R3 stated he/she receives a shower once a week. R4 stated he/she takes 4 showers a week. R6 stated he takes 2 showers a week. 3 Out of 7 residents ( R3, R4, R6) stated the facility staff do their laundry once a week. 2 Out of 7 residents (R5, R7) stated they do their own laundry and shower themselves.

On October 3, 2025, Licensing Program Analyst Steve Chang interviewed residents R8-R13. 2 Out of 6 residents (R8, R9) stated the facility does their laundry once per week. 4 Out of 6 residents ( R10-R13) stated they do their own laundry. 6 Out of 6 residents (R8-R13) stated they have a shower every week.

On October 3, 2025, LPA Steve Chang interviewed ADM Kellie Shearer. ADM stated usually the facility residents has 2 showers per week. ADM stated R1 has one shower per week because R1 does not like to have shower and sometimes refuses showers. ADM stated staff changed R1's clothes every day. ADM stated R1 has laundry completed once per week or as needed.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 15

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
07/07/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250707122429

FACILITY NAME:	WATERMARK AT SAN JOSE, THE		FACILITY NUMBER:	435202937
ADMINISTRATOR:	KELLIE SHEARER		FACILITY TYPE:	740
ADDRESS:	1017 S BASCOM AVE		TELEPHONE:	(520) 797-4000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	205	CENSUS:	DATE:	02/20/2026
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Human Resurce Director (HRD) Carolina Villar-Mata		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not have adequate transportation for the residents
Staff reported wrong incident information to family

INVESTIGATION FINDINGS:

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On July 7, 2025 the Department received a complaint alleging Staff do not have adequate transportation for the residents.

On July 14, 2025, Licensing Program Analyst Steve Chang interviewed Former Administrator, Kellie Shear (ADM). ADM stated the facility has scheduled transportation 7 days for field trip, store outing, and for residents' needs. ADM stated residents need to schedule 24 hours in advance. ADM stated the facility provides the service for drop-off and pick-up. ADM stated the facility also provides the service of dropping residents at doctor office and picking up from doctor office. ADM stated resident/family needs to schedule/request the transportation with the front desk staff.

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

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

LIC9099 (FAS) - (06/04)

Page: 5 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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On January 20, 2026, LPA Manuel Monter interviewed Witness W1. W1 stated he/she had booked a dentist appointment for R1 a few weeks in advanced. W1 stated he/she was called by an unknown staff member asking if they could drop off R1 an hour earlier. W1 stated he/she was told that day they needed to transport another resident. W1 stated he/she told them they couldn’t do that and leave R1 alone at the dentist. W1 stated he/she canceled the transport. RP stated he/she picked up R1 and took him/her to the dentist.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed residents R14-R18. 3 Out of 5 residents (R14,R16,R18) interviewed were unable provide any relevant information due to neurocognitive disorder. 2 Out of 5 residents (R15,R17) stated their family takes them to their appointments.

On January 23, 2026, LPA Manuel Monter interviewed Staff S2-S6. 4 Out of 5 staff (S2-S5) stated they are not aware or have knowledge about the facility transportation. S6 stated there was a request to take R1 to a dentist appointment. R1’s family member (FM) wanted the driver to sit there parked until R1’s FM arrived. S6 stated there was a large time the driver would have to wait. S6, stated the facility asked if they could possible change the schedule. S6 stated FM canceled the appointment all together. S6 stated the transportation event didn’t even occur.

On February 5, 2026, LPA Manuel Monter interviewed staff S7-S10. 3 Out of 4 staff (S7, S9, S10) stated they are not aware of or don’t have knowledge about the facility transportation. S8 stated the issue, regarding the facility transportation, is residents will make an appointment, but then will change their mind. S8 stated the residents will ask to change their schedule and get upset when the facility is not able to meet their last-minute request.

LPA Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1. S1 stated, Family’s will request transportation, for medical appointments. S1 stated Transportation requests go thru the front desk and see if they can fit it in the schedule. S1 stated she is not aware of any issues regarding the facility’s ability to provide transportation to residents.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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LPA Manuel Monter interviewed Community Life Director (CLD) Barbra Fleig. CLD stated, CLD stated she is aware of what occurred regarding R1’s transportation. CLD stated R1 was scheduled to go with another resident, on the transportation van. CLD stated they were going to ask the driver to take R1 to him/her appointment and wait for R1’s FM to arrive. CLD stated they ask the driver’s to accompany the residents inside or wait for their family members to watch over the residents. CLD stated they don’t leave residents there and just leave them unattended.

CLD stated they informed FM ahead of time, they would arrive to the appointment and would wait for FM to arrive. CLD stated she spoke with R1’s FM and told him/her that the driver was going to be there. CLD stated FM didn’t want R1 to wait for her and canceled the appointment. CLD stated R1 wasn’t taken to his/her appointment by the facility because R1’s FM cancelled. CLD stated she called ahead of time, a few days in advanced, when speaking with the FM.

On February 11, 2026, LPA Manuel Monter interviewed residents R5, R6, R19-R22. 6 out of 6 residents (R5, R6, R19-R22 ) stated they have used the facility transportation and have not had any issues.

On February 9 & 17, LPA Manuel Monter interviewed staff S11 and S12. Staff S11 stated he/she is now are of or have knowledge regarding the facility’s transportation. S12 stated he/she is aware that resident who lived in the assisted living side, had issues with setting up their appointments, but didn’t have knowledge of the issues regarding this assisted living resident. S12 stated he/she was aware there was also issues regarding R1’s transportation, but stated he/she has no knowledge regarding this event.

The Department reviewed Facility Transport Appointment form, regarding R1. The form states the transport request was submitted on April 9, 2025, for an appointment on April 21, 2025. Furthermore, the form states, R1 was scheduled to arrive at the appointment early, but driver was instructed to wait until his/her family member arrived. Community Life Director informed the family member prior to appointment day. R1's family member requested to cancel. R1's family member didn't want R1 to arrive early.

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 6

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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Staff reported wrong incident information to family

On July 7, 2025 the Department received a complaint alleging Staff reported wrong incident information to family.

On July 14, 2025, Licensing Program Analyst Steve Chang conducted the initial complaint investigation visit.

On January 20, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she was informed about an incident that occurred at the facility with incorrect information. W1 stated he/she was called by an unknown staff, telling him/her that there was an altercation with 3 residents. RP stated he/she was initially told that R1 was holding a knife and was in an argument with another resident. RP stated he/she was contacted moments later informed that the information he/she received was incorrect and R1 was not holding the knife, but was verbally aggressive with another resident and the third resident was holding the knife. W1 stated he/she was called during the same day and informed about the mistake, within a few hours, but reiterated, he/she does not remember the exact time. W1 stated he/she believes this occurred in Spring 2025.

On January 23, 2026, LPA Manuel Monter interviewed staff S2-S6. 5 Out of 5 staff (S2-S6) stated they are not aware of any incident where a resident in the memory care unit got a hold of a knife.

On January 23, 2026, LPA Interviewed Assisted Living Director ALD Mayte Calderon. ALD stated she is not aware of any incident where a resident in the memory care unit got a hold of a knife.

On February 5, 2026, LPA Manuel Monter interviewed Staff S7-S10. 4 Out of 4 staff (S7-S10) stated they are not aware of any incident where a resident in the memory care unit got a hold of a knife.

On February 5, 2026, LPA Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1. S1 stated she does remember an incident where a resident got a hold of a knife. MCD stated she can’t remember the name of the resident. MCD stated she doesn’t’ remember.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 8 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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On February 5, 2026, LPA Manuel Monter interviewed Community Life Director (CLD) Barbara Fleig. CLD stated she does remember an incident where a resident got a hold of a butter knife, in spring 2025. CLD mentioned possible names but does not remember.

On February 11, 2026, LPA Manuel Monter interviewed Executive director (ED) Brenda Ritter. ED stated she isn’t aware of any instance where a resident in the memory care unit got a hold of a knife. ED stated if there was any issue like reporting the wrong information due to new information being discovered, then the facility would call back the responsible party and apologize for the mistake.

On February 9 & 17, 2026, LPA interviewed staff S11 and S12. S11 stated regarding the incident with the knife: he/she doesn't remember the details. S11 stated he/she had just started her shift and had done his/her endorsement with the previous nurses. S11 stated sometime after, a care giver came to him/her and told him/her a resident had a knife and was arguing.

S11 stated when he/she arrived there were already 3 care givers in between the residents separating them / redirecting them away from each other and the butter knife had been taken from the resident. S11 stated he/she cannot remember the details of the event but believes the residents involved could have been R23 and R24. S11 stated no one was injured from the incident. S11 stated once he/she was informed about the incident he/she or one of the managers did inform the residents responsible parties. S11 stated after their team had gotten the full story from all the care givers, they then realized that R1 was not involved in the incident, in which then the Responsible party of R1 was called and informed the same day.

S12 sated he/she is aware of the incident that occurred in the memory care unit, regarding the butter knife. S12 stated there were 2 residents that were arguing with each other, then another resident also joined in the argument. S12 stated he/she thinks the resident with the knife was R24. S12 acknowledged that it was reported to R1’s FM, that R1 had the knife, which was inaccurate. S12 stated the facility later called R1's daughter to apologize for the incorrect information that was provided, due to additional information, after a debriefing was completed with the care givers who witnessed the event. S12 stated that he/she does not remember the details since he/she did not actually witness the event.

Page 5 Out of 6

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 9 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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The Department reviewed resident R23 and R24's Progress notes. Progress note dated March 2, 2025 states staff S11, Heard commotion in the hallway. R23 was noted in the hallway in front of apartment door. Two residents were in the hallway being separated by 3 care givers. 1 care giver informed S11 that R24 had a knife and was trying to stab R23. S11 redirected R24 to his/her apartment.

Although it is a fact that incorrect information was initially reported to R1’s responsible party, once the facility became aware of the error, they promptly contacted the responsible party to advise them of the mistake. Furthermore, based on interviews conducted, the inaccurate information was identified and the responsible party was provided with the correct information on the same day.

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 6 Out of 6.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 10 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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On January 20, 2026, LPA Manuel Monter interviewed Witness W1. W1 stated the facility is supposed to do R1’s laundry once a week. W1 stated whenever he/she would visit, R1’s laundry would be over flowing. W1 stated the laundry would be overflowing within a couple days. W1 stated it was just constantly overflowing. W1 stated R1 should receive 2 showers per week, but W1 found many times that R1 did not receive 2 showers per week. W1 stated he/she would shower R1 many times. W1 stated he/she cannot provide the exact days when this occurred it has occurred multiple times during R1’s stay at the facility.

On January 23, 2026, LPA Manuel Monter interviewed residents R14-R18. 4 Out of 5 residents (R14-R17) stated they do not need assistance with showers and have not had any issues regarding their showering needs. 4 Out of 5 residents (R14-R17) stated they have not had any issues regarding his/her laundry service. R18 was unable to provide relevant information due to neurocognitive disorder.

On January 23, 2026, LPA Manuel Monter interviewed staff S2-S6. 5 Out of 5 staff (S2-S6) stated they is not aware of any instance where a resident was neglected their shower or a residents laundry service needs that were neglected.

On January 23, 2026, LPA Manuel Monter interviewed Assisted Living Director (ALD) Mayte Calderon. ALD stated residents showers are done via schedule. ALD stated if a resident has an accident, staff will clean up that resident. ALD stated she is not aware or hasn’t seen any or heard about a resident being neglected their shower. ALD stated residents laundry is done at least once a week, via shower schedule. ALD stated she isn’t aware of any instance of a residents laundry service needs being neglected.

On January 23, 2026, LPA Manuel Monter toured the memory care unit inside and out. LPA toured the following bedrooms: 234, 236, 238, 240 A+B, 242, 244, 246, 247, 249, 248, 250, 253, 252, 254, 257, 256, 259 A+B, 258, 222, 221 A+B, 218, 220, 216 A+B, 214, 212, 210, 209, 208, 207, 205, 206, 203, 200 A+B, 201 A+B. During the tour of the memory care unit, LPA did not observe any areas as unclean, unhygienic or disorderly. LPA did not observe any residents in a disheveled state or with soiled clothing.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 12 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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On February 5, 2026, LPA interviewed Maintenance Director Mithun Prasad (MD). MD stated the laundry is done at least once a week or more if requested. MD stated if the resident has an accident, then laundry will be done as well. MD stated there have not been any issues the facility washing machine or dryer. MD stated each floor of the facility has 3 washing machines and dryers. MD stated the basement has a commercial grade washer and dryer machines as well. MD stated during his rounds he hasn’t observed residents laundry services / needs being neglected. MD stated he has not observed over a weeks worth of laundry pilled in residents bedrooms. MD stated he hasn’t seen any residents who have been neglected their showering needs.

On February 5, 2026, LPA Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1. S1 stated residents laundry is clean via the laundry schedule. S1 stated the care givers do the laundry. S1 stated they wash the residents close at least weekly or more if needed. S1 stated there has never been a time when she observed residents laundry needs neglected or resident laundry pilling up, resulting in more than a weeks worth of dirty laundry. S1 stated residents are showered via shower schedule. S1 stated they follow the shower schedule. S1 stated some residents might refuse, but they will try with a different person, and make sure the resident received their shower. S1 stated even if a resident refuses, that day, staff will give that refusing resident a sponge bath. S1 stated she is not aware of any instance where a resident was not given or neglected their shower.

On February 5, 2026, LPA Manuel Monter interviewed Community Life Director (CLD) Barbra Fleig. CLD stated there has never been a time when she observed residents laundry needs neglected or resident laundry pilling up, resulting in more than a weeks worth of dirty laundry. CLD stated he/she is not aware of any instance where a resident was not given or neglected their shower.

On February 5 and 9, 2026, LPA Manuel Monter interviewed staff S7-S11. 3 Out of 5 staff (S7, S9, S10 ) stated they is not aware of any instance where a resident was neglected their shower or a residents laundry service needs that were neglected.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 13 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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S8 stated there were times when the residents laundry needs were being neglected. S8 stated this also occurred in the June-August 2025 time period. S8 stated he/she can’t say a specific example but stated he/she remembers that during that time period there was a lot of difficulty regarding residents laundry. S8 stated the care givers in the morning shift would say the next shift will do it, and would neglect the laundry. S8 stated this was addressed some time last year. S8 stated he/she is not aware of any instance where a resident was not given or neglected their shower. S11 stated he/she did not observe any instance where residents laundry needs were being neglected. S11 stated he/she did not shower any residents during his/her shift.

On February 11, 2026, LPA Manuel Monter interviewed Residents R5, R6, R19-R22. 2 Out of 6 residents (R5, R6) stated they receive laundry services and have not had any issues. R6 stated he/she does need assistance with showers and has not had any issues with the assistance the facility is providing regarding showers. 5 Out of 6 residents (R5, R19 R20, R21, R22) stated they do not need assistance with showers and have not had any issues regarding his/her showering needs. 4 Out of 6 residents (R19 R20, R21, R22) stated they do their own laundry.

On February 11, 2026, LPA Manuel Monter interviewed Executive Director (ED) Brenda Ritter. ED stated she heard there was some miscommunication on who washes what back in the summer of 2025. ED stated she isn’t privy to the details since she wasn’t there. ED stated during her time at the facility, there hasn't been any issues regarding laundry services being neglected. ED stated she isn’t aware of any instance where staff did not provide residents with their showers. ED stated she isn’t aware of a resident being neglected their shower for over a week.

On February 17, 2026, LPA interviewed staff S12. S12 stated the care givers do the laundry for the residents at least once a week. S12 stated he/she never saw residents laundry pile up more than a weeks worth of laundry. S12 stated they actually washed the residents cloths more than once a week because memory care residents go thru a lot of clothing.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

Page: 14 of 15

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 02/20/2026

NARRATIVE

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S12 stated he/she is not aware of any instance where a resident wasn’t assisted with their showers. S12 stated one of the residents family's members alleged their parent was not being bathed. S12 stated he/she did go ask the care giver that was assigned to shower that resident that day, but the staff member stated that he/she didn't do it due to a refusal. S12 stated the resident’s family was convinced the staff were not even attempting to shower her mother. S12 stated he/she did provide his/her contact information to the family member and encouraged him/her to contact S12 if he/she suspected a shower wasn't given to instruct staff to shower the resident the moment its brought up.

S12 stated they did have trouble at the time with residents who refused showers, but they would do their best to try different methods to shower the residents. S12 reiterated, even though there were residents who would refuse, those residents would eventually be showered and weren't neglected.

Based on investigation, records 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 allegations did or did not occur.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

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