435294345-10-29-2021-26-AS-RMAO-C9AMDD-20211201083059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 10/29/2021
Date Signed: 10/29/2021 12:58:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/17/2020 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20200417170402

FACILITY NAME:	WESTMONT OF MORGAN HILL		FACILITY NUMBER:	435294345
ADMINISTRATOR:	STEVEN SILACCI		FACILITY TYPE:	740
ADDRESS:	1160 COCHRANE RD		TELEPHONE:	(408) 779-8490
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	112	CENSUS: 71	DATE:	10/29/2021
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Jolie Higgns		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Resident was sexually assaulted while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Christine Dolores conducted an unannounced Complaint Investigation to deliver findings of the above allegations and met with Executive Director, Jolie Higgins.

On 04/21/2020, the Department conducted an initial complaint investigation wherein the LPA requested documents.

Between 8/19/2020 – 10/9/2020, the Department interviewed 8 staff members (S1 – S8). Based on interviews, staff were not aware of any abuse in the facility. Staff stated that R1 had multiple falls, but never expressed any concern or being abused by other residents or staff. Staff stated that R1 was cognizant but confused at times though able to verbalize the need for an assistance with bladder management. Staff stated residents' showers are provided by various staff, mostly female staff. R1 requires 2-person assist.

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021

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-20200417170402

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: WESTMONT OF MORGAN HILL	FACILITY NUMBER: 435294345
	VISIT DATE: 10/29/2021

NARRATIVE

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On 04/11/2020, R1 was noted by facility staff to have green pus, foul odor and blood when changing R1's undergarment. R1 complained of leg pain and burning sensation. This incident was reported and R1 was taken to the hospital.

R1 was interviewed. Despite R1's neurocognitive disorder, R1 does not remember going to the hospital on 04/11/2020 but does remember being admitted to the hospital for urinary tract infection (UTI). R1 denied recent sexual activity and being mistreated or sexually abuse by any staff members. R1 states feeling safe at the facility.

Based on records review, R1 was admitted into the hospital on 04/11/2020 wherein R1 was indicative of a sexually transmitted infection and result of tests were negative. Test results revealed that R1 had inflammation of the bladder and subsequently treated for urinary tract infection (UTI). R1 has a history of UTI in 2019 and 2020.

This Department has investigated this allegation. Based on interviews conducted, records reviewed, and LPAs observation, the Department has found that this allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview conducted with Executive Director, Jolie Higgins and a copy provided.

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SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021

LIC9099 (FAS) - (06/04)

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