435294345-12-15-2022-26-AS-KHOS-CP5KKL-20230217065828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 12/15/2022
Date Signed: 12/15/2022 09:50:20 AM

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
01/27/2021 and conducted by Evaluator Christine Dolores

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20210127155001

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: 74	DATE:	12/15/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jolie Higgins		TIME COMPLETED:	09:55 AM

ALLEGATION(S):

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Resident suffering from dehydration

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding of the above allegation. LPA met with Executive Director, Jolie Higgins.

On 01/27/2021, the Department received a complaint that a resident suffered from dehydration. On 1/28/2021, an initial investigation was conducted. From 02/01/2021 – 02/03/2021, three hospice care staff were interviewed. Documents were obtained to include resident (R1)’s hospice records. On 12/08/2022, additional documents were obtained to include R1's physician's report, needs and services plan, and narrative charting.

Based on record review and interview, R1 was under hospice care.

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: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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-20210127155001

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: 12/15/2022

NARRATIVE

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Three hospice care staff were interviewed. Based on the interviews, R1 was being visited by Hospice between three to five times a week. When asked a routine question on the status of the resident’s condition, facility staff stated R1 would eat almost 100% of all their meals. R1 had a behavior in opening their mouth constantly, regardless if food or drinks were offered. It was undetermined whether this was related to R1’s medical diagnosis or hunger. When given water during a hospice care visit, R1 observed to finished two full glasses and appeared to be thirsty. According to the interviews, there was no indication that facility staff had neglected R1 or refused to provide food or fluids to R1.

Based on record review, R1 was dependent for all Activities of Daily Living (ADLs). R1 was being administered multiple medications in which one of side effects may be constipation. Throughout December 2021, R1’s main medical concern was constipation with no mentions or signs of dehydration. In January 2021, notes indicated that R1 was eating well. R1’s doctor instructed facility staff to encourage fluids daily as tolerated to promote bowel movement. In January 2021, there was no mention of R1 showing signs of dehydration. Given R1’s medical diagnosis, R1 remained at risk for multiple medical issues which included dehydration.

Based on record review, a home health aide (HHA) from the hospice agency informed staff that prior to the hospice nurse visiting R1, HHA had also offered fluids and applesauce but R1 refused and spit it out.

The Department has investigated the above allegation. Based on interviews and record review the Department has determined that the above allegation 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 Executive Director, 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: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC9099 (FAS) - (06/04)

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