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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201413
Report Date: 04/08/2026
Date Signed: 04/08/2026 04:58:44 PM

Unfounded


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
01/09/2026 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20260109082544
FACILITY NAME:CEDAR CREEK ALZHEIMER'S & DEMENTIA CARE CENTERFACILITY NUMBER:
435201413
ADMINISTRATOR:MICHELLE WHITEFACILITY TYPE:
740
ADDRESS:15245 NATIONAL AVENUETELEPHONE:
(408) 356-5636
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:58CENSUS: 44DATE:
04/08/2026
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Community Outreach Sabrina SneperTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Staff do not serve residents food of good quality.
Staff do not communicate with responsible party regarding resident's care.
Staff do not provide responsible party with facility policies and procedures.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with Community Outreach (CO) Sabrina Sneper.

On 01/09/2026, the Department received a complaint with the above 3 allegations.

On 01/15/2026, the Department conducted an initial investigation visit.

LPA interviewed ADM, 5 staff, and 3 residents.

LPA requested resident R1's care plan, centrally stored medication forms, Medication administration records, and physician reports.

Continue on LIC9099-C. Page 1 of 4.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 26-AS-20260109082544
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: CEDAR CREEK ALZHEIMER'S & DEMENTIA CARE CENTER
FACILITY NUMBER: 435201413
VISIT DATE: 04/08/2026
NARRATIVE
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Staff do not serve residents food of good quality:
The allegation is that the facility meal food was not served hot, milk was not hot to serve to residents, and milk was not filled full in the cup/glass to residents.

On 01/15/2026, LPA interviewed Administrator (ADM) Michelle White. ADM stated every resident receives plenty of food for the meals. ADM stated the kitchen staff prepare food/meals for resident based on their order/preference. ADM stated meals are placed on the plates, and caregivers deliver to dining table in the dining room for residents. ADM stated some residents have special diets, and the kitchen staff prepare the special diet the for the residents. ADM stated caregivers do not push or hurry residents to finish the meals, and some residents take up to one hour or one and half hours to finish meals. ADM stated the facility has the food temperature log for the meal food when meals are ready to deliver to residents to make sure meals are warm/hot to deliver to residents. ADM provided the meal temperature log. ADM stated milk is served around 40 degree F as around the same as in the refrigerator temperature. ADM stated that is the usual way people drink milk. ADM stated residents can request to heat the milk if they prefer hot milk. ADM stated usually the milk or beverage is not served full of the cup/glass because residents may spill out if not carefully. ADM stated resident can request more milk or beverage if needed.

LPA interviewed two kitchen staff (S1, S2). Both stated resident meals are prepared based on residents' order/preference and are placed on plates, and caregivers deliver meals to residents. Both stated residents' meals are put in oven before delivered to residents. Both stated the kitchen staff keep meal temperature log.

LPA interviewed 2 caregivers (S3, S4). Both stated milk is not served as hot milk and residents can request to heat the milk. Both stated milk is not served as full glass/cup because resident may spill out. Both stated they deliver meals from kitchen to residents.

Based on the review of the meal temperature log, the meals were kept warm/hot and milk and beverage were kept around 40 degree F before delivered to residents.

Based on the review of the facility food menu, protein, Carbohydrates, and vegetables are provided everyday to residents.

Continue on LIC9099-C. Page 2 of 4.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 26-AS-20260109082544
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: CEDAR CREEK ALZHEIMER'S & DEMENTIA CARE CENTER
FACILITY NUMBER: 435201413
VISIT DATE: 04/08/2026
NARRATIVE
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Staff do not communicate with responsible party regarding resident's care:
The allegation is that family member (FM) was not aware of resident R1 uses wheelchair due to facility staff did not notify FM..

On 01/15/2026, LPA interviewed Administrator (ADM). ADM stated resident R1 already used walker and wheelchair when the new management team took over the facility. ADM stated R1 prefers to sit because R1 has pain knees. ADM stated the facility encourages R1 to walk with walker for exercise. ADM stated R1 has physical therapy treatment. ADM stated based on R1's plan of care dated 05/22/2025, R1 was able to ambulate with 4-wheeled walker and after 05/16/2025, R1 used a wheelchair all the time and had not been ambulating in the facility. ADM stated R1's family member visits R1 very often and should be aware of R1 used wheelchair before October 2025. LPA interviewed 2 caregivers (S3, S4). Both stated R1 used walker and wheelchair before October 2025 and needs staff assistance.

Based on the review of R1's Physical Therapy Plan of Care approval for R1 dated 05/22/2025, R1 used a wheelchair all the time and had not been ambulating in the facility since 05/16/2025.

Staff do not provide responsible party with facility policies and procedures:
The allegation is that staff did not respond to family member (FM) the request of facility's policies, procedures and plan of operation.

On 01/15/2026, LPA interviewed Administrator (ADM). ADM stated he/she did not receive any request for facility policies and procedures from FM but he/she helped Community Outreach (CO) to prepare the document of the facility Plan of Operation, the facility emergency plan, the facility policy and procedures.

LPA interviewed Community Outreach (CO). CO stated he/she received a request for application package from FM. CO stated he/she gave a whole package of documents including but not limited to, application procedures, admission agreement, plan of operation. CO stated after he/she provided the whole package of document to FM, FM did not complain and did not request any more document. CO provided a copy of the application package.
LPA interviewed a Med Tech (S5). S5 stated FM requested Medication Administration Records (MARs). S5 stated he/she provided the MARs to FM.
Continue on LIC9099-C. Page 3 of 4.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 26-AS-20260109082544
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: CEDAR CREEK ALZHEIMER'S & DEMENTIA CARE CENTER
FACILITY NUMBER: 435201413
VISIT DATE: 04/08/2026
NARRATIVE
1
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The Department has investigated the above allegations. Based on the investigation, observation, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

No citations noted at today’s compliant investigation visit. Exit interview conducted with CO. This report was provided to review and for signature. A copy of this report was provided to CO.

Page 4 of 4.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
01/09/2026 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20260109082544

FACILITY NAME:CEDAR CREEK ALZHEIMER'S & DEMENTIA CARE CENTERFACILITY NUMBER:
435201413
ADMINISTRATOR:MICHELLE WHITEFACILITY TYPE:
740
ADDRESS:15245 NATIONAL AVENUETELEPHONE:
(408) 356-5636
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY:58CENSUS: 44DATE:
04/08/2026
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Community Outreach Sabrina SneperTIME COMPLETED:
10:05 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not distribute resident's medication as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with Community Outreach (CO) Sabrina Sneper.

On 01/09/2026, the Department received a complaint with the allegation that staff did not distribute resident's medication as prescribed..

On 01/15/2026, the Department conducted an initial investigation visit.

LPA interviewed ADM, 5 staff, and 3 residents.

LPA requested resident R1's care plan, centrally stored medication forms, Medication administration records, and physician reports.
Continue on LIC9099-C. Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 26-AS-20260109082544
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: CEDAR CREEK ALZHEIMER'S & DEMENTIA CARE CENTER
FACILITY NUMBER: 435201413
VISIT DATE: 04/08/2026
NARRATIVE
1
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Staff did not distribute resident's medication as prescribed:

The allegation is that facility staff did not distribute resident R1's medication M1 on 12/03/2025 for PM shift.

On 01/15/2026, LPA interviewed a Med Tech (S5). S5 stated one day in December 2025. R1's family member (FM) took R1 for doctor appointment. FM requested R1's MAR. S5 stated he/she provided R1's MARs to FM and FM found on 12/03/2025, PM shift, the item of R1's medication M1 without staff initial. S5 stated he/she knew R1's M1 was administered for 12/03/2025 PM shift but just the Med Tech (S6) forgot to initiate it. S5 stated he/she explained it to FM.

On 01/17/2026, 11:20AM, LPA interviewed Med Tech(S6). S6 stated he/she did administer medication M1 to R1 on 12/03/2025, at bedtime but he/she forgot to initiate it. S6 stated he/she initiated it at another day.

Based on the review of R1's December 2025 MARS, on 12/03/2025, the medication M1 PM shift was observed with staff initial.

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

No deficiencies or citations noted at today’s compliant investigation visit. Exit interview conducted with CO. A copy of this report was provided to CO.

Page 2 of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6