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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294345
Report Date: 08/25/2021
Date Signed: 08/25/2021 04:22:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:WESTMONT OF MORGAN HILLFACILITY NUMBER:
435294345
ADMINISTRATOR:BILLY MITCHELLFACILITY TYPE:
740
ADDRESS:1160 COCHRANE RDTELEPHONE:
(408) 779-8490
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:112CENSUS: 58DATE:
08/25/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Billy MitchellTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Christine Dolores and Marybeth Donovan conducted an unannounced Case Management Visit. LPAs met with Billy Mitchell, Executive Director (ED), Jocelyn Bailon, Compass Rose Resident Service Director, and Jeeteeh Gigliotti, Resident Service Director. LPAs explained the purpose of the visit to obtain additional information related to 4 incident reports received for the period 7/18/2021 to 7/25/2021 involving resident (R1). 911 was called for each of these incidents.

LPAs toured the facility in part to include the lobby, dining room and Compass Rose Memory Care area and outdoor courtyard.

LPAs interviewed ED and two staff LPAs reviewed resident (R1's) records to include physician reports, health and services evaluation reports, service plan and physician communications.

R1 transitioned from Assisted Living to Memory Care unit on 7/15/2021. R1 exhibited exiting behaviors from the Memory Care unit. Staff were monitoring R1's transition. Family and primary care provider (PCP) were notified of changes in condition. Care conference was held to discuss plan of care. Staff directed to contact 911 in the event of emergency and for safety of residents in care and staff.

No citation issued per the California Code of Regulations Title 22.

Reviewed the report with Billy Mitchell, Executive Director and a copy provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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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