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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202759
Report Date: 11/19/2025
Date Signed: 11/19/2025 03:18:09 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
08/22/2025 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20250822164951
FACILITY NAME:WESTGATE VILLAFACILITY NUMBER:
435202759
ADMINISTRATOR:TAYAG, AIDAHFACILITY TYPE:
740
ADDRESS:5425 MAYME AVENUETELEPHONE:
(408) 366-6510
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:60CENSUS: 58DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Aidah TayagTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility staff did not ensure that resident's private parts are cleaned thoroughly when changed.
Facility staff did not safeguard resident's personal valuables/belongings.
Facility staff is not providing personal hygiene care to resident
Facility staff is not dressing the resident for bed.
Facility staff did not report concerns brought to their attention.
Facility staff is not providing liquids to resident resulting in dehydration.
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 Executive Director (ED) Aidah Tayag.

On 08/22/2025, the Department received a complaint with above allegations.

On 08/28/2025, the Department conducted an initial investigation visit. LPA interviewed 4 facility staff, a resident, and a family member. LPA obtained the physician report, appraisal needs and service plan of resident R1.

On 10/01/2025, LPA conducted an investigation visit and interviewed Executive Director (ED) and a hospice care nurse.

Continue on LIC9099-C. Page 1 of 5.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 5
Control Number 26-AS-20250822164951
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: WESTGATE VILLA
FACILITY NUMBER: 435202759
VISIT DATE: 11/19/2025
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Facility staff did not ensure that resident's private parts are cleaned thoroughly when changed:

On 09/28/2025, LPA interviewed the facility Director of Nursing (DN). DN stated that the caregivers provide proper incontinence care with soap and water during changing of adult briefs especially when resident has a bowel movement. DN stated caregivers provide proper incontinence care using incontinence sanitary wipes if they have episodes of urine incontinence and caregivers will change the resident with new adult briefs. DN stated caregivers check/change resident R1's diaper every two hours.

LPA interviewed 2 caregivers who have taken care of resident R1. Both caregivers stated they wash R1 if they find feces on the diapers when they change R1's diaper. Both caregivers stated they wipe R1 if they find urine on the diaper when they change R1's diaper. Both caregivers stated they check/change R1's diaper every two hours.

LPA interviewed R1's family member (FM), POA of R1. FM stated he/she visits R1 3 to 4 times per week. FM stated he/she changes diaper for R1 whenever he/she visits R1. FM stated he/she never saw feces, urine or not clean in R1's private area when he/she changes R1's diaper. FM stated the facility staff change R1's diaper every two hours.

On 10/01/2025, LPA interviewed executive Director (ED) Aidah Tayag. ED stated resident R1 is always kept clean and in hygiene. ED stated R1 receives diaper change every two hours and after toileting. ED stated caregivers wipe R1 if urine was found on the diaper when changing R1's diaper. ED stated caregivers wash R1 if found feces on the diaper when caregivers change R1's diaper.

ED stated caregivers call Med Tech, Nurse, or management to assist if R1 refused to change diaper.

LPA interviewed a hospice care nurse (N1). N1 stated he/she comes on site to take care of R1 every week. N1 stated hospice care aide comes on site to help R1 for showers, hygiene, changing diapers every Wednesday and Friday. N1 stated the facility provides good care to R1.

Continue on LIC9099-C. Page 2 of 5.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 26-AS-20250822164951
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: WESTGATE VILLA
FACILITY NUMBER: 435202759
VISIT DATE: 11/19/2025
NARRATIVE
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Facility staff did not safeguard resident's personal valuables/belongings:
On 08/28/2025, LPA interviewed Director of Nursing (DN). DN stated there was a incident before regarding resident R1 missed valuables. DN stated the facility conducted an investigation, and the finding is UNFOUNDED.

LPA interviewed resident R1's family member (FM), R1's POA in financial and in health. FM stated before R1 moved in the facility, he/she received a notice from the facility, do not bring any expensive or valuables in the facility. FM stated R1 does not bring any valuables in the facility. FM stated R1 is forgetful and is with neurocognitive issue. FM stated sometimes R1 forgot he/she displaced something. FM stated he/she bought a headband for R1 which R1 likes. FM stated one day R1 found another resident has the same headband on the head. FM stated R1 might be confused the headband is his/hers. FM stated the price of the headband is $3.00.

On 10/01/2025, LPA interviewed ED. ED stated he/she notified R1's family, R1's POA, do not bring any valuable personal belongings to the facility. ED stated R1 did not bring any valuable personal belongings to the facility. ED states R1 is forgetful with neurocognitive issue and without any valuable belongings in the facility.

Facility staff is not providing personal hygiene care to resident:
On 08/28/2025, LPA interviewed Director of Nursing (DN). DN stated resident R1 has 2-3 showers per week. DN stated R1 has a laundry per week. DN stated all the residents have at least 2 times teeth brushing every day. DN stated R1 receives teeth blushing after wake up and after meals.

LPA interviewed 2 caregivers who have provided care to R1. Both stated they provide 3 times teeth brushing to R1 during their shifts.

On 10/01/2025, LPA interviewed ED. ED stated R1 has 3 showers per week, two from hospice care aide, and one from the facility caregiver. ED stated R1 has 2 laundries per week. ED stated R1 did not have rash on skin. ED stated R1 has one deep cleaning for the room per week. ED stated staff provide R1 house keeping maintenance daily. ED stated R1 receives teeth blushing in the morning and before bed time daily..
Continue on LIC9099-C. Page 3 of 5.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 26-AS-20250822164951
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: WESTGATE VILLA
FACILITY NUMBER: 435202759
VISIT DATE: 11/19/2025
NARRATIVE
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LPA interviewed hospice care nurse (N1). N1 stated hospice care aide come on site twice per week to provide showers, grooming, hygiene, changing diaper, dressing, and mouth care to R1.

Facility staff is not dressing the resident for bed:
On 8/28/2025, LPA interviewed DN. DN stated AM shift caregivers dress residents up in the morning when get up, and PM shift caregivers change resident to have pajama on when get to bed.

LPA interviewed R1's family (FM), POA in financial and in health. FM stated he/she visits R1 3 to 4 times per week. FM stated he/she observed R1 was changed to pajamas for bed time.

On 10/01/2025, LPA interviewed ED. ED stated staff help R1 to have pajama on before goes to bed every day, and gets change to wear day clothes in the morning every day. ED stated management always checks all residents to wear appropriate dressing every day. ED state Med Tech and caregivers always check and verify residents are dressed appropriately before going to bed.

Facility staff did not report concerns brought to their attention:
On 8/28/2025, LPA interviewed DN. DN stated he/she did not receive any complaint from R1's family.
LPA interviewed Marketing Director (MD). MD stated he/she was told by R1's family member (FM), POA, that only to answer the general question regarding R1, and let FM to answer for any sensitive information regarding or care plan about R1 if anyone asks. MD stated he/she did not receive any complaint regarding R1.

LPA interviewed R1's family member (FM), R1's POA. FM stated he/she knows another R1's family member brought some supplement to R1 but those were not doctor order, so the facility refused to give to R1.

On 10/01/2025, LPA interviewed ED. ED stated there is no complaints or concern from R1's family. ED stated one of R1's family member asked about R1's care plan, but that family member is not R1's POA. ED stated the facility provided R1's care plan to R1's POA and asked the other R1's family member to talk with R1's POA. ED stated the facility policy is that resident's care plan, medical information are only provided to resident's POA.
Continue on LIC9099-C. Page 4 of 5.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20250822164951
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: WESTGATE VILLA
FACILITY NUMBER: 435202759
VISIT DATE: 11/19/2025
NARRATIVE
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Facility staff is not providing liquids to resident resulting in dehydration:

On 8/28/2025, LPA interviewed DN. DN stated R1 has water at meals and has water between meals/events.

LPA interviewed 2 caregivers who have provided care to R1. 1 out of 2 caregivers stated he/she gives water to R1 as needed. The other caregiver stated he/she gives water to R1 every two hours.

LPA interviewed R1's family member (FM), POA in financial and in health. FM stated he/she visits R1 3-4 times per week. FM stated he/she observed R1 has water or drinks for the meals. FM stated he/she observed staff provided water or drink to R1 between meals.

On 10/01/2025, LPA interviewed ED. ED stated the facility staff hydrate R1 every meal and R1 is offered water another 3 times between meals. ED stated the activity staff passing liquid to R1 and residents during the activity.

Based on the interview on 08/28/2025 with R1's family member (FM) and the explanation on the email that FM sent to LPA on 09/15/2025, FM stated he/she is R1's POA in financial and in heath and all the allegations of the complaint are not true. FM stated the facility staff provide good care to R1.

The Department has investigated the above allegations. Based on the investigation, record reviewed, and interviews conducted, the Department found that the above allegations are UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

No citation noted today. Exit interview was conducted with ED. The report was provided to ED for signature. A copy of the report was provided to ED.

Page 5 of 5.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5