435294345-8-11-2023-26-AS-RMAO-CVDT9E-20230905143149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 08/11/2023
Date Signed: 08/11/2023 05:39:12 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
10/07/2020 and conducted by Evaluator Simranjit Rai

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20201007102938

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:	09:15 AM
MET WITH:	Administrator, Jolie Higgins		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff did not respond to call button in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Simi Rai, Steve Chang, and Manuel Monter conducted an unannounced complaint investigation regarding the above allegation. LPAs met with Executive Director (ED) Jolie Higgins and stated the purpose of the visit.

On 10/7/2020, the Department received a complaint with the above allegation. On 7/13/2020, the Department conducted interview with former Executive Director. Due to COVID19 preventative measures, CCLD has suspended on-site visit and this was a tele-visit.

Continuation on LIC 9099-C.
Page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	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)

Page: 1 of 5

Control Number 26-AS-20201007102938

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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Page 2 of 2.

During visit, LPAs interview ED. ED stated he/she began his/her employment in 2021 after this complaint was received by the Department. LPAs interviewed Staff S1-S3.

During visit, LPAs requested a current roster of staff and residents. LPAs received Stanley Healthcare signal systems invoice 5/25/2023, R1's Narrative Charting from 9/10 - 9/14/2020, and R1's Hospice Visit Communication 9/12-9/14/2020.

Staff did not respond to call button in a timely manner.

On 8/11/2023, the Department interviewed ED. ED stated the staff need to respond to the resident's call pendent within 12 minutes. Per ED, the facility changed the signal system to a new model. Per Stanley Healthcare Invoice from 5/25/2022, the facility installed the new call system. 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 1 of 3 staff stated the previous signal system would not clear the call pendent signal after assisting the resident, which is why the facility replaced the signal systems.

During today's visit, LPAs pulled the emergency cord in one of the restrooms located on the first floor next to the dining room. LPAs observed facility staff respond to the emergency cord in less than a minute.

Based on the interviews conducted with clients and staff, based on observation and records 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.

No deficiencies cited and exit interview conducted with Executive Director, Jolie Higgins and a copy of the report was provided.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	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)

Page: 2 of 5

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
10/07/2020 and conducted by Evaluator Simranjit Rai

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20201007102938

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:	09:15 AM
MET WITH:	Administrator, Jolie Higgins		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Facility did not issue a refund.
Staff did not seek medical attention in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Simi Rai, Steve Chang, and Manuel Monter conducted an unanounced complaint investigation regarding the above allegations. LPAs met with Executive Director (ED) Jolie Higgins and stated the purpose of the visit.

On 10/7/2020, the Department received a complaint with the above allegations. On 7/13/2020, 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.

Continuation on LIC 9099-C.
Page 1 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	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)

Page: 3 of 5

Control Number 26-AS-20201007102938

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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Page 2 of 3.

During visit, LPAs interview ED. EDstated he/she began his/her employment in 2021 after this complaint was received by the Department. LPAs interviewed R1's responsible party. LPAs requested a current roster of staff and residents. LPAs reviewed R1's Admission Agreement, Email Communication, R1's Move Out Notice, and R1's refund check.

Facility did not issue a refund.

Based on record review of R1’s signed admission agreement by R1's responsible party, on page 12 of 69, the document states “You may terminate this agreement at any time…by giving the executive director thirty (30) days’ prior written notice…You will continue to be responsible for your full monthly fee until the thirty (30) day period has expired." Per interview with ADM, the facility did not have another verbal or documented agreement in place, besides the admission agreement signed by responsible party.

Based on record review of email communications between R1’s responsible party and the facility on 9/14/2020 and R1’s responsible party notified the facility he/she wanted to terminate the contract effective the same day and facility accepted the email notification as a 30-Day Notice.

Based on record review of R1’s move out notice signed by the responsible party, the form states R1’s responsible party gave move out notice on 9/14/2020. The form also states “by signing and submitting this form you will be giving the required 30-day notice. The last day of your notice will be 10/14/2020.”

Based on record review of facility’s copy of R1 refund check. The form states the refund was given on 10/30/2020 and was cashed out on 12/01/2020. On 8/11/2023, LPA interviewed R1’s responsible party. Responsible party confirmed the address on the check was his/her home but could not confirm if check was received.

Continuation on Page 3 LIC-9099.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	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)

Page: 4 of 5

Control Number 26-AS-20201007102938

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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Page 3 of 3.

Staff did not seek medical attention in a timely manner.

Based on record review of R1's Narrative Charting 9/12/2020 at 9pm, the Medication Technician (MT) during the shift reported R1's child was with resident when he/she stated R1 was "having a stroke". MT checked on the resident right away and called the Hospice agency. While MT was connecting with Hospice Nurse, R1's child spoke to Hospice Nurse and describe R1's symptoms. Per R1's Narrative Charting, Hospice Nurse advised R1's child to administer PRN medication after hearing R1's symptoms.

Based on record review of R1's Hospice Visit Communication on 9/12/2020, Hospice LVN visited R1 the same to assess the resident at the facility. Per notes, R1's child stated R1 had anxiety attack and was asleep during visit. Based on record review, two subsequent visits were made by the Hospice Nurse on 9/13/2020 and 9/14/2020 wherein R1 was observed to be alert and did not have symptoms of stroke.

The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

No deficiencies cited and exit interview conducted with Executive Director, Jolie Higgins and a copy of the report was provided.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Simranjit Rai	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)

Page: 5 of 5