435294345-9-15-2022-26-AS-KHOS-CKHJFC-20221024070032

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:15:36 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
09/06/2022 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20220906164346

FACILITY NAME:	WESTMONT OF MORGAN HILL		FACILITY NUMBER:	435294345
ADMINISTRATOR:	JOLIE HIGGINS		FACILITY TYPE:	740
ADDRESS:	1160 COCHRANE RD		TELEPHONE:	(408) 779-8490
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	112	CENSUS:	DATE:	09/15/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Jolie Higgins		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff discontinued resident services without adequate notice

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the initial complaint investigation and met with Executive Director, Jolie Higgins and Resident Service Director (RSD), Ria Hernandez.

During visit, LPA toured the assisted living section with RSD. LPA interviewed residents R1 – R6 and staff member, S1. The following records were obtained to include the resident roster, staff roster, facility’s admission agreement, monthly menu, resident counsil meeting minutues, and R1 – R9’s physician’s report and needs and services plan.

See LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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-20220906164346

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: WESTMONT OF MORGAN HILL	FACILITY NUMBER: 435294345
	VISIT DATE: 09/15/2022

NARRATIVE

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Based on interview, 6 out of 6 residents states to be receiving all services. 6 out of 6 residents states the facility was supplying the residents with water bottles but that service had been discontinued recently. Residents are informed they are now responsible in supplying their own water bottles, if preferred. 6 out of 6 residents states the facility does provide drinking water.

The facility held a requested resident council meeting on 08/31/2022 and resident council meeting on 09/06/2022 to discuss the discontinuation of water bottles. Residents were informed of the discontinuation of the supply of water bottles through a resident council memo that was placed in the resident's mailbox on 09/06/2022.

LPA interviewed the Executive Director, who states the supply of water bottles were a courtesy to the residents during outbreaks of communicable diseases. The purpose of supplying the residents with water bottles were to reduce the spread of the communicable disease.

Based on records review, the supply of water bottles is not part of the resident’s services. The discontinuation of the water bottles were part of the resident council minutes that was provided to each resident.

LPA observed the facility to have multiple hydration stations that are readily available to the residents.

The Department has investigated the above allegation. Based on interviews and records review, the Department has determined that the above allegations is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Jolie Higgins and a copy of the report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC9099 (FAS) - (06/04)

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