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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294345
Report Date: 02/20/2024
Date Signed: 02/20/2024 04:53:29 PM


Document Has Been Signed on 02/20/2024 04:53 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:JOLIE HIGGINSFACILITY TYPE:
740
ADDRESS:1160 COCHRANE RDTELEPHONE:
(408) 779-8490
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:112CENSUS: 72DATE:
02/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:JOLIE HIGGINSTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required 1- year annual inspection. LPA met with Executive Director (ED) Jolie Higgins.

LPA entered the kitchen with the ED. Refrigerator temperature maintained at 32 degrees F and freezer temperature maintained at 1 degree F. Facility has at least 7 days worth of non-perishables and 2 days worth of perishable foods. Items inside the refrigerator observed covered and labeled. Fire extinguisher last serviced on 05/30/2023. Facility has sufficient amount of silverware and dishes.

LPA toured Compass Rose (aka Memory Care) with ED to include 6 resident apartments (RM 137B, 133, 130, 128, 124, and 123), bathrooms, activity room, dining room and exterior. Temperature in memory care maintained at 74 degrees Fahrenheit. Hot water temperature in RM 133 maintained at 110 degrees Fahrenheit. Oxygen in use signs posted in appropriate areas. All chemical, disinfectants, and hygiene items observed secured. Residents observed participating in activities during visit. 1 out of 2 egress doors in the patio observed in disrepair as the egress door does not open or alarm. The facility has another fire exit egress door in the patio area in case of emergency. 1 egress door inside memory care observed in disrepair and does not alarm. Facility initially had a latch lock on the door installed at the very top of the door that is not within arms length. LPA advised to remove the latch lock on the door in case of emergency. Facility staff immediately removed the lock and taped multiple caution tape signs on the door. Facility placed the lock temporarily to avoid resident elopements while they wait for the door to be repaired. The facility scheduled technicians to repair the egress doors this week. SEE LIC809-C.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
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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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: 02/20/2024
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LPA reviewed 4 resident files in memory care contained a signed admission agreement, updated medical assessment, TB result, service plan, consent form, and personal rights form. 3 out of 4 residents uses oxygen and has a physician order for oxygen on file. 2 out of 4 residents uses half rails and has a physician's order for half rails on file. LPA reviewed 4 resident centrally stored medication records and centrally stored medication. 1 out of 4 resident was missing 1 PRN medication that was not written in the centrally stored medication record. LPA observed the facility has the physician's order on file along with the PRN log.

LPA toured Assisted Living with ED to include 6 resident apartments (RM 247, 239, 236, 229, 226, and 225) bathrooms, and common areas. Temperature maintained at 74 degrees F. Hot water temperature in RM 247 AND 236 observed at 112 degrees F. LPA observed the residents are provided with an activity schedule weekly. 1 stairwell observed free and clear of obstruction with a stairwell chair. LPA reviewed 4 resident files in Assisted Living contained a signed admission agreement, medical assessment, TB result, service plan, consent form, and personal rights form. LPA reviewed 4 residents centrally stored medication records. LPA observed 2 medications were not part of the centrally stored medication records for 2 out of 4 residents. LPA observed the physician's order for each medication. Staff immediately inputted the medication on the centrally stored medication record. 5 residents were interviewed in their apartments.

LPA reviewed 6 staff records to include a fingerprint clearance, health screening, TB result, employee rights, and job application. 1 out of 6 staff members had a 1st Aid Certification. Facility has at least one person per shift who has a first aid certification. Facility has a scheduled 1st Aid certification course scheduled on 02/26/2024. LPA reviewed staff training records included training on topics to include but not limited to medication, dementia/Alzheimer, postural supports, and hospice care. LPA recommended to document the hours for each in-service training. Facility has an updated emergency disaster plan. Fire drills are being conducted quarterly with the drills dated on 11/2023, 12/2023, and 01/2024.

No deficiencies are being cited per California Code of Regulations, Title 22. Advisory notes provided. This report was reviewed with Executive Director, Jolie Higgins, Resident Care Director, Ria Hernandez and Memory Care Director, Myrene Carasi and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
LIC809 (FAS) - (06/04)
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