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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294345
Report Date: 07/07/2021
Date Signed: 07/08/2021 08:05:05 AM

Document Has Been Signed on 07/08/2021 08:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HILLFACILITY NUMBER:
435294345
ADMINISTRATOR:BILLY MITCHELLFACILITY TYPE:
740
ADDRESS:1160 COCHRANE RDTELEPHONE:
(408) 779-8490
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 112CENSUS: 69DATE:
07/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Billy MitchellTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Karen Taku conducted an unannounced Case Management visit today. LPA met with the Executive Director (ED) Billy Mitchell and the Resident Services Director (RSD’s) of Assisted Living -Jeeteeh Gigliottii and Memory Care-Jocelyne Bailon.

The purpose of today’s visit is to conduct a welfare check on a resident (R1) who resides in Memory Care.

Per the ED and RSD’s, R1 is doing and eats well. R1 had a couple falls last week and sustained no injuries. Per RSD, R1 wants to remain as independent as possible, but due to R1’s health condition (Alzheimer Dementia w/Behavioral Disturbances), R1 doesn’t realize assistance is needed. Per RSDs, to minimize additional incidents, R1 was given a pendant to call for assistance and Occupational Therapy, to ensure R1 knows how to properly transport using a walker and wheelchair.

R1’s Physician's Report, Assessment, and Care Plan were reviewed during today's visit.

At 11:18am, LPA observed R1 having a snack and speaking to staff. R1 appeared to be in good spirts.
At 11:25am, LPA attempted to speak with R1. R1 was sitting in wheelchair with eyes slightly closed and vocal. R1 stated, doing okay and didn't have any concerns.

Per Lifestyle Director, R1 is fairly involved in activities. R1 enjoys being read to, coloring, and the weekly scenic drive.

No deficiencies cited during today’s visit. This report was reviewed with the ED and a copy was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Karen Taku
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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