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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202775
Report Date: 09/18/2024
Date Signed: 09/18/2024 03:46:48 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
07/08/2024 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20240708094345
FACILITY NAME:WATERMARK AT ALMADEN, THEFACILITY NUMBER:
435202775
ADMINISTRATOR:RONALD ELLENICHFACILITY TYPE:
740
ADDRESS:4610 ALMADEN EXPRESSWAYTELEPHONE:
(669) 258-4567
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:240CENSUS: 145DATE:
09/18/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Executive Director, Corey MillerTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Facility did not address water leak in resident's room.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Simi Rai and Marcella Tarin conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Executive Director, Corey Miller and stated the purpose of today’s visit.

On 07/08/2024, the Department received a complaint with the above allegation. On 07/16/2024, the Department conducted an initial investigation at the facility.

On 07/05/2024, resident R1 discovered water in R1's room. It was alleged the facility did not address the water leak in resident's room.

Continuation on LIC 9099-C, Page 1 of 2.

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
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 2
Control Number 26-AS-20240708094345
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: WATERMARK AT ALMADEN, THE
FACILITY NUMBER: 435202775
VISIT DATE: 09/18/2024
NARRATIVE
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Page 2 of 2.

On 7/16/2024, LPA Rai interviewed Maintainence Director (MD) Wes McKinley. MD stated his department received work order on 07/05/2024 regarding a water leak in R1's room and bathroom. MD stated his team addressed the issue the next day 07/06/2024 and followed up on 07/07/2024.

On 7/26/2024, LPA Rai interviewed resident R1. R1 stated the water was leaking from the roof to the floor on 7/5/2024. R1 stated facility staff responded the same day with the care staff drying the floor and submitting a work order on R1's behalf. R1 stated the maintenance staff responded the next day 7/6/2024 and resolved the issue on 7/7/2024.

Based on review of work order form 07/05/2024 to 07/09/2024, facility staff created work order for the day of the incident on 7/5/2024 and the maintainence staff did respond to the work order on 7/6/2024, 7/7/2024 and 7/9/2024.

The Department has completed the investigation of the above allegation. Based on interviews conducted and record reviews, the Department has found that the above allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or are without a reasonable basis.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2