435294345-8-13-2023-26-AS-RMAO-CURKGV-20230816075411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 08/11/2023
Date Signed: 08/13/2023 09:21:17 AM

Unsubstantiated

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
04/25/2022 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20220425155409

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: 76	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jolie Higgins		TIME COMPLETED:	04:47 PM

ALLEGATION(S):

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Staff are not assisting resident with incontinence needs.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Steve Chang, Simi Rai and Manuel Monter conducted an unannounced investigation visit and met with Executive Director (ED) Jolie Higgins.

On 4/25/2022, the Department received a complaint with the above allegation. On 5/5/2022, an initial investigation visit was conducted.

During today's investigation, LPAs interviewed ED and Resident Service Director Ria Hernandez (S1).

LPAs reviewed R1's physician report, and R1's Care Plan.

Continue on LIC9099-C, page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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 2

Control Number 26-AS-20220425155409

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: 08/11/2023

NARRATIVE

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On 8/11/2023 around 1:00PM, LPAs interviewed ED. ED stated the facility staff checks incontinent residents every two hours to assess if the resident needs assistance. ED stated residents on incontinence service program can call for assistance as needed. ED stated R1 participated the incontinence service program.

LPAs reviewed R1's care plan, R1 participated the facility incontinence service program.

Around 1:20 PM, LPAs interviewed Resident Service Director (S1). S1 stated caregivers check incontinent residents every two hours including the bed time and as needed. S1 stated resident can call staff if assistance is needed. Based on record review, facility stated they were tracking R1's incontinence needs but the facility staff could only produce records for two weeks.

The Department has investigated the above allegation. Based on interviews, and record review, the department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid, there is not a preponderance of evidence to show the alleged violations did or did not occur.

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

This report was provided to ED for review. A copy of the report was provided to ED.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2