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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202775
Report Date: 12/16/2024
Date Signed: 12/16/2024 06:09:01 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
06/10/2024 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20240610163702
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: 147DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Executive Director, Corey MillerTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility did not submit Death Report for a resident.
Facility did not submit Incident Reports for positive COVID-19 cases.
Facility did not maintain to cool rooms to a comfortable range between 78 degrees F and 85 degrees F.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Executive Director, Corey Miller and stated the purpose of today’s visit.

On 6/10/2024, the Department received a complaint with the above allegations. On 6/14/2024, the Department conducted an initial investigation at the facility.

Continuation on LIC 9099-C, Page 1 out of 3.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 4
Control Number 26-AS-20240610163702
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: 12/16/2024
NARRATIVE
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Page 2 of 3.

Facility did not submit Death Report

It was alleged the facility did not submit a Death Report for a resident (R1) who passed away at the facility.

Based on record review of Death Reports submitted by the facility to the Department, facility did submit the Death Report for R1 in a timely manner.

Facility did not submit Incident Reports for positive COVID-19 cases.

It was alleged the facility did not submit Incident Reports to the Department for residents who tested positive for COVID-19.

Based on record review of Incident Reports submitted by the facility to the Department from January 2024 - June 2024, facility did submit the Incident Report for COVID-19 positive cases at the facility and report the cases to the local Public Health Department.

Facility did not maintain to cool rooms to a comfortable range between 78 degrees F and 85 degrees F.

It was alleged the resident (R2) was not able to adjust the thermostat to the room and the common room.

On 6/14/2024, LPA Rai toured the facility, LPA Rai observed the temperature in the common areas to include the restaurant, lounge, hallways, and activity room, and randomly two resident rooms including R2’s room. LPA Rai observed the temperatures were within 78 degrees F and 85 degrees F. LPA Rai observed the thermostat in the common areas and resident rooms wherein staff and residents may adjust the temperature.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20240610163702
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: 12/16/2024
NARRATIVE
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Page 3 of 3.

On 6/14/2024, the Department interviewed 1 staff (S1). S1 stated there weren’t any issues with the central cooling and heating unit. S1 stated he/she did not hear or observe any issues with the temperature in the facility. S1 stated the residents are able to adjust their own apartment temperatures but the system is capable to maintain the temperatures between 78 degrees F and 85 degrees F.

On 6/14/2024, the Department interviewed 7 residents (R1-R7). Seven out of seven residents stated they did not have issues with the thermostat located in their room and the common room. Seven out of seven residents stated they were able to adjust the temperature of their room. R2 demonstrated how to change the temperature in the common room and adjust the temperature in R2’s room.

On 12/16/2024, LPA Rai reviewed work orders for R2’s room from April 2024 – June 2024 and two out of two work order did not pertain to R2’s thermostat not working in R2’s room.

The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were 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: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4