435294345-9-20-2023-26-AS-KHOS-CWVMBD-20231023092747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 09/20/2023
Date Signed: 09/20/2023 02:57:55 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
07/20/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20230720102657

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:	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jolie Higgins		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not file resident's insurance paperwork for payment

INVESTIGATION FINDINGS:

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

On 07/20/2023, the Department received the complaint. On 07/28/2023, the initial complaint investigation was conducted. It was alleged the facility staff did not file resident (R1)'s insurance paperwork for reimbursement since January 2023.

Documents were obtained for this investigation to include the resident roster, staff schedule for July 2023, staff roster, resident (R1) admission agreement, physician’s report, service plan, and insurance invoices from November 2022 – June 2023.

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: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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-20230720102657

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: 09/20/2023

NARRATIVE

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On 07/20/2023, 2 staff members were interviewed regarding the allegation. Based on interview, the facility was only notified of this issue in June 2023 and acted immediately after. Notifications regarding R1's insurance were being sent to R1's responsible party. S1 stated that the facility provided a courtesy service to assist resident (R1) in filing their insurance paperwork every month. S1 states based on their contract this task is not the facility’s responsibility, but is the responsibility of either the resident and/or family.

It was stated that R1’s insurance paperwork was delayed for 6 months due to the need of an updated assessment from the insurance company. The Memory Care Director who would have been responsible for filing the insurance paperwork during these months does not currently work for the facility.

The review of records does not state a written agreement regarding the facility’s responsibility to file insurance paperwork for resident(s).

The Department has investigated the above allegation. Based on interview, record review and observation 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 prove the alleged violation 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: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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