435294345-9-20-2023-26-AS-KHOS-CYEQGX-20231211111015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 09/20/2023
Date Signed: 09/20/2023 02:59:26 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
09/11/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20230911135649

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:	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 does not allow resident to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to open the initial complaint investigation. LPA met with Executive Director (ED) Jolie Higgins.

On 09/11/2023, the Department received a complaint alleging staff did not allow resident (R1) to have visitors. On 09/20/2023, the initial complaint investigation was conducted.

The following documents were obtained for this investigation to include resident (R1)’s physician’s report, service plan, identification and emergency information, Power of Attorney (POA) information, progress notes, visitation list, and facility’s visitor log from 08/29/23 and 09/11/23. 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-20230911135649

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 09/20/2023, 1 staff member and 2 witnesses were interviewed.

Based on staff interview, the facility was provided a visitation list signed by the resident (R1) and R1’s POA during admission. The list includes a list of residents who are allowed to visit and not visit R1. The list was maintained at the front desk. It was explained that if a visitor from the list were to arrive to the facility, the Executive Director (ED) would still ask R1 if he/she would like to see the visitor per the resident’s right. ED stated that R1 refused to see visitors.

The review of records show that R1 signed a list of visitors who were allowed to visit and not allowed to visit R1. On 08/28/2023, the facility received communication to add another visitor to the “no visit” list.

Based on interview with witness (W2), it was R1’s decision to put together a list of people who can visit and not visit R1.

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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