435294345-8-11-2023-26-AS-RMAO-CUWMAG-20230821092619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 08/11/2023
Date Signed: 08/11/2023 05:25:12 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
08/25/2020 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20200825152249

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: 76	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Jolie Higgins		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff are not responding to resident's call button in a timely manner.
Resident's dietary requests are not being met.
Facility failed to maintain resident's room in good repair

INVESTIGATION FINDINGS:

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On 08/11/2023, Licensing Program Analysts (LPA's) Steve Chang, Manuel Monter and Simi Rai conducted an unannounced complaint investigation regarding the allegations above. LPAs met with Administrator (ADM) Jolie Higgins.

On 08/20/2020, the Department received a complaint with the above allegations. On 9/04/2020, the Department conducted interview with former Administrator (ADM). Due to COVID19 preventative measures, CCLD has suspended on-site visit and this was a tele-visit.

Resident's dietary requests are not being met

LPAs interviewed ADM. ADM stated it is facility's policy to follow the pre-set menu for the week. ADM stated if a resident has a special dietary requirement, the facility will provide those options.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
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)

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Control Number 26-AS-20200825152249

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: 08/11/2023

NARRATIVE

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Based on record review of R1's physicians report sign & dated 2/20/2019, R1 does not have a special diet. LPA requested 2020 facility menu, ADM stated facility menu for the year 2020 is not available.

LPA interviewed Food Service Director (FSD). FSD stated he/she does not recall complaints or interactions from R1. FSD stated he/she only follows the pre-set menu and has never deviated from the menu.

Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Staff are not responding to resident's call button in a timely manner.

The incident occurred on 8/23/2020 and 8/25/2020 where R1's pendent was not answered for over an hour.
On 8/10/2023, the Department interviewed ADM. ADM stated the staff need to respond to the resident's call pendent within 12 minutes. Per ADM, the facility changed the signal system to a new model. Per Stanley Healthcare Invoice the facility installed the new call system on 5/25/2022. Per ADM, the facility does not have records from the previous signal system which was used when the incident occurred.

Based on interview of S1-S3 who worked at the facility in 2020, 3 of 3 staff members stated the resident's pendent would be cleared within 10 minutes and 2 of 3 staff stated the previous signal system would not clear the call pendent signal after the resident was assisted, which is why the facility replaced the signal systems.

Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
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)

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Control Number 26-AS-20200825152249

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: 08/11/2023

NARRATIVE

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Facility failed to maintain resident's room in good repair

It has been alleged that the facility does not respond to work orders.

LPAs interviewed ADM. ADM stated the facility will assist if the residents notify maintenance via work order. ADM stated, as long as it is requested, the facility will address the issue. ADM stated how quickly they address the work order depends on the priority level. ADM stated if its high priority, like something that may endanger a resident, then it will be address immediately. ADM stated if its low priority, then that will take longer to address. ADM wanted to note that the facility will fix the things the facility is responsible but will not fix the residents personal property.

ADM stated that the refrigerators does make a noise which is normal when the refrigerator is functioning properly. ADM stated if there was noise coming from the fridge would be considered a potential health and safety risk for the resident, then the facility would remove the fridge. ADM also stated if the residents fridge is not working, they will replace it the same day.

ADM stated maintenance will do rounds one a month, which includes, but not limited to, changing filters and inspecting residents apartments. ADM stated if maintenance sees an issue during the monthly rounds, it will be addressed immediately.

LPAs reviewed facility work orders made by R1. R1 work order request made on 08/09/2020 was completed on 8/19/2020. R1's work order on 8/26/2020 was completed on 8/27/2020. R1's work order on 8/27/2020 was completed on 8/27/2020.

LPA did not interview maintenance director. The maintenance director who worked during the time period of the complaint no longer works at the facility.

Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
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)

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