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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294345
Report Date: 10/22/2025
Date Signed: 10/22/2025 12:05:47 PM

Document Has Been Signed on 10/22/2025 12:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HILLFACILITY NUMBER:
435294345
ADMINISTRATOR/
DIRECTOR:		JOLIE HIGGINSFACILITY TYPE:
740
ADDRESS:1160 COCHRANE RDTELEPHONE:
(408) 779-8490
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 112CENSUS: 85DATE:
10/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Administrator Michael FountainTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit to follow up regarding an incident report, which stated a resident had eloped from the facility. LPA met with Administrator (ADM) Michael Fountain. LPA explained the purpose of the visit.

On October 16, 2025, the Department received an incident report (IR) from the facility. The IR stated, on October 15, 2025, around 7:20pm, medtech noticed R1 was not in their bedroom. After double checking the room, medtech alerted staff and initiated a thorough search of the community. The resident was located outside the community by a care giver and was safely escorted back inside. No injuries were observed.

On October 17, 2025, LPA Manuel Monter interviewed Resident Services Director (RSD), Jmy Ramos. RSD stated R1 was found at target. (Based on a google Maps search, Target is 0.4 miles away from Westmont of Morgan hill.) RSD stated one of the care givers found him/her. RSD stated the care giver, Staff S4 had already clocked out, and happened to be at target, he/she recognized R1, at around R1 was found. RSD stated S4 saw R1 and recognized him/her. RSD stated R1 was found around 8:10pm.

RSD stated R1 has wandering behavior. RSD stated, based on what she knows, R1 used to live at assisted living, and moved to memory care in July 2025. RSD stated R1 cannot leave the facility unassisted.

RSD stated she isn't sure how R1 got out of the memory care, or which door, RSD stated the staff claimed they didn't hear the door alarms make a sound. RSD stated she tested the doors the next day, and the alarms did sound. RSD stated the executive director also tested the same day of the elopement and the alarm sounded. Page 1 Out of 3.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 10/22/2025
NARRATIVE
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On October 20, 2025, LPA Manuel Monter interviewed staff S1-S3. All staff interviewed stated R1 has exit seeking behavior. All staff interviewed stated they did not hear the delayed egress alarm activate/ring. S1 stated the day of the elopement, after taking R1 for a walk he/she took R1 back to his/her bedroom. S1 stated he/she went to pass out medications for the residents. S1 stated she started from the entrance of the memory care unit. S1 stated while she was going through her routine, she eventually got to R1, and R1 wasn’t there. S1 stated he/she doesn’t know how R1 exited the memory care unit.

S2 stated on October 15, 2025, staff S1 and R1 went walking. S2 stated they came back around either, 6:40pm or 6:20pm. S2 stated S1 took R1 back to her room. S2 stated that is the last time he/she saw R1. S2 stated he/she was assisting a resident to bed when the elopement occurred.

Staff S3 stated resident R1 is an exit seeker. S3 stated R1 is one of the main residents that tries to exit seek. S3 regarding the elopement: Around 7pm, was the last time he/she saw R1. S3 stated when he/she saw R1 in hallways, passing the dining room, headed to the TV. S3 stated he/she was going to use the restroom. S3 stated when he/she exited the bathroom, S1 asked if he/she has seen R1.

LPA Monter interviewed Memory Care Coordinator, Rohit Singh, referred to as MCC. MCC stated R1 has sun downing and exit seeking behavior everyday. MCC stated R1 was assigned, in terms of groupings, to staff S1. MCC stated staff are supposed to supervise residents they are assigned to.

The Department reviewed R1's Service plan, dated March 24, 2025. The service plan states, under the section, Wandering and Elopement, that R1 needs frequent supervision and redirection due to wandering outside and/or off community premises. Exits must be monitored due to elopement risk. Further more, the service plan states R1 has exit seeking behavior during the day and night; and R1 has prior history of elopement.

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NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 10/22/2025
NARRATIVE
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The Department reviewed R1's Physician's Report, dated April 8, 2025. The report states R1 has a neurocognitive disorder and cannot leave the facility unassisted.

As a result, the department issued an immediate civil penalty of $500 for the absence of supervision, which resulted in R1 eloping from the facility.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D.
This report was reviewed with Administrator Michael Fountain and a copy of the report was provided. Appeal Rights was provided.

END OF REPORT

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NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/22/2025 12:05 PM - It Cannot Be Edited


Created By: Manuel Monter On 10/22/2025 at 10:00 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: WESTMONT OF MORGAN HILL
FACILITY NUMBER: 435294345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2025
Section Cited
CCR
87468.2(a)(4)

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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) (4) To care, supervision, and services that meet their individual needs and are delivered by staff … to meet their needs.
This requirement was not met as evidence by:
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ADM they have provided in-service for daily door checks. ADM stated they also updated the delayed egress doors codes. ADM stated they had the do company inspect the doors as well. ADM stated they also did an in-service regarding elopement.
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Based on interview and records reviewed, on October 15, 2025, R1, who has a neurocognitive disorder left the memory care unit unassisted and was found 0.4 miles away from the facility. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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ADM stated he would send LPA the plan of correction by POC due date, October 23, 2025.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Manuel Monter
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2025


LIC809 (FAS) - (06/04)
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