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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435294143
Report Date: 06/07/2023
Date Signed: 06/07/2023 08:13:03 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
06/23/2022 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20220623103245
FACILITY NAME:SOUTH COUNTY RETIREMENT HOME INC.FACILITY NUMBER:
435294143
ADMINISTRATOR:APOSTOL, SAMUEL C.FACILITY TYPE:
740
ADDRESS:460 CHURCH AVENUETELEPHONE:
(408) 683-0229
CITY:SAN MARTINSTATE: CAZIP CODE:
95046
CAPACITY:46CENSUS: 46DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
06:56 PM
MET WITH:Samuel ApostalTIME COMPLETED:
08:09 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility temperature is uncomfortable for residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/07/2023, LPA's conducted a complaint investigation regarding the alligations above.

Based on allegation that on 6/15/2022 the facility indoor was at 82 degrees F. Some residents alleged it was hot that night and asked staff if they could turn on AC but staff refused.

Based on San Martin weather.com on 6/15/2022, the tempreture of the area was a high of 91F and a low of 54 degrees F. LPA's interviewed more or less 10 residents. No resident complained about the facility's tempreture. R1 stated the temperature can get hot but prefers to keep window closed. R2 stated the facility temperature does get hot but they have a fan to mitigate the temperature.

ADM stated that if the tempretures get hot; the facility will turn on the AC and provide waters to the residents. ADM stated if a resident complained about the tempreture, then they will adjust the thermostat.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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 3
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
06/23/2022 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20220623103245

FACILITY NAME:SOUTH COUNTY RETIREMENT HOME INC.FACILITY NUMBER:
435294143
ADMINISTRATOR:APOSTOL, SAMUEL C.FACILITY TYPE:
740
ADDRESS:460 CHURCH AVENUETELEPHONE:
(408) 683-0229
CITY:SAN MARTINSTATE: CAZIP CODE:
95046
CAPACITY:46CENSUS: DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
06:56 PM
MET WITH:TIME COMPLETED:
08:09 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not serving variety of Food.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/07/2023, LPA's conducted a complaint investigation regarding the alligations above.

Based on interviews with residents more or less about 20 residents were interviewed. According to residents the have no complaints regarding the food. During investigation LPA inspected facility food supply for perishable and non perishable food. The facility had adequte food supply including fruits, vegetables and a variety of canned foods. LPA's obsereved the facility's food log which notes what food they make. LPA observed on previous visit, 5/19/23 and current visit 6/7/23, a varitety of food was given to residents.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel MonterTELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3