435294345-9-30-2021-26-AS-RMAO-C7PPR9-20211011113221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294345
Report Date: 09/24/2021
Date Signed: 09/30/2021 11:06:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/22/2019 and conducted by Evaluator Yatfai Ng

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20190722105729

FACILITY NAME:	WESTMONT OF MORGAN HILL		FACILITY NUMBER:	435294345
ADMINISTRATOR:	STEVEN SILACCI		FACILITY TYPE:	740
ADDRESS:	1160 COCHRANE RD		TELEPHONE:	(408) 779-8490
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	112	CENSUS: 72	DATE:	09/24/2021
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Jolie Higgins		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Facility not providing services agreed to in Admissions Agreement.
Staff failed to provide activities for resident(s).
Resident(s) not provided adequate amount of food.
Resident(s) not provided adequate amount of water.
Staff failed to assist resident(s) with toileting needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an unannounced subsequent complaint investigation visit. LPA met with Executive Director Jolie Higgins.

An initial unannounced investigation was conducted by LPAs Yatfai Eric Ng and Gladys Kuizon on 7/25/2019. LPAs toured the facility and interviewed 2 residents. A subsequent unannounced investigation was conducted by LPA Ng on 9/17/2019. LPA interviewed additional 7 residents, and 2 staff. On 10/18/2019, LPA Ng conducted another subsequent unannounced investigation. LPA interviewed 4 residents, and 3 staff.

Investigation visits conducted on 7/25/2019, 9/17/2019, and 10/18/2019, LPA Ng toured the facility. On 7/25/2019, LPA observed memory care unit residents were watching movie in library room. On 9/17/2019, LPA observed memory care unit residents were having a game in activity room. On 10/18/2019, LPA observed memory care unit residents were doing crafts in the activity room. LPA observed residents participated the activities.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Yatfai Ng	TELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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-20190722105729

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 HILL	FACILITY NUMBER: 435294345
	VISIT DATE: 09/24/2021

NARRATIVE

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Based on review of the facility monthly calendar, there were daily activities in the facility from morning to afternoon and sometimes nighttime. For example, on 7/3/2019 the facility had morning exercise starting at 10:00 AM, BBQ in courtyard starting at 11:30 AM, and afternoon stretch, sponge art, bingo, and documentary starting at 1:15 PM. Another example, on 7/26/2019, the facility had morning exercise and daily chronicle with coffee starting at 10:00 AM, exercise with James, name that tune, sensory hand washing starting at 10:30 AM, sightseeing, bingo, and movie night starting at 1:00 PM.

On 7/25/2019, LPA Ng interviewed 2 residents with null result.

On 7/25/2019, LPA Ng interviewed 1 visitor of the resident. 1 out of 1 visitor stated the family had adequate food and water upon request. 1 out of 1 visitor stated the toileting need of the resident was met.

On 7/25/2019, LPA Ng toured 2 residents’ rooms in the facility. 2 out of 2 residents needed assistance in toileting needs. Based on observation, LPA did not smell any foul odor inside the room. Thus, LPA did not observe any residents’ toileting needs were not met.

On 9/17/2019, LPA Ng toured 1 resident’s room in the facility. 1 out of 1 resident needed assistance in toileting need. Based on observation, LPA did not smell any foul odor inside the room. Thus, LPA did not observe any residents’ toileting needs were not met.

On 9/17/2019, 8 residents were interviewed with 5 results. 5 out of 5 residents stated that they did not feel the food and water were not adequate for them. 5 out of 5 residents stated their toileting needs were met. 5 out of 5 residents were not aware any resident’s food, drink, and toileting needs were not met.

On 9/17/2019, 1 visitor of the resident was interviewed. 1 out of 1 visitor stated the family had adequate food and water upon request. 1 out of 1 visitor stated the toileting needs of the resident was met.

On 9/17/2019, LPA interviewed 1 staff who was responsible to address the toileting needs of the residents. 1 out of 1 staff stated the residents in need, were checked at least 4 times per shift, 2 times per night, at least 8 times per day.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Yatfai Ng	TELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20190722105729

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 HILL	FACILITY NUMBER: 435294345
	VISIT DATE: 09/24/2021

NARRATIVE

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On 10/18/2019, LPA interviewed 4 residents. 4 out of 4 residents stated there were adequate food and water in the facility. Based on observation, LPA did not smell any foul odor from the 2 out of 4 residents who needed assistance in toileting needs. Thus, LPA did not observe any resident’s toileting need was not met.

On 10/18/2019, LPA interviewed 1 staff who was an activity director. 1 out of 1 staff stated many residents who were in memory unit liked to watch old television based on her professional experience. Showing modern television shows irritated some residents. Beside television shows, the entertainment system in the facility could also act as a karaoke, and gaming machine to entertain the residents. Due to physical and health condition, the family of R1 refused the facility to have R1 to participate the activities with other residents.

On 10/18/2019, LPA interviewed 2 staff. 2 out of 2 staff stated care staff developed a system to check the residents in need routinely in order to make sure the residents’ needs were being met.

Based on observation, LPA observed there were activities provided to residents who participated. LPA observed residents had their meals and observed staff assisting residents in eating and drinking. Also, LPA did not observe any residents’ toileting needs were not met.

It was alleged that a med tech would serve R1 24 hours a day, that at least 3 staff available at all times, and the resident would be checked on every 10 minutes. Although it was alleged that it was agreed to provide a copy of admission agreement to LPA, LPA did not receive it when requesting it on 7/24/2019, and on 9/10/2019. No document was provided to support the allegation. Based on record review, LPA obtained a copy of the R1’s admission agreement documents from the facility. In reviewing the documents, the terms and agreements on services wherein the facility failed to provide to R1 are not mentioned.

This Department has investigated the above allegations. Based on observations, interviews conducted and records review, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

This report was reviewed with Executive Director and a copy of this report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Yatfai Ng	TELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

LIC9099 (FAS) - (06/04)

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