<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202780
Report Date: 12/19/2024
Date Signed: 12/19/2024 03:15:23 PM

Unsubstantiated


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
07/18/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220718113427
FACILITY NAME:SONNET HILLFACILITY NUMBER:
435202780
ADMINISTRATOR:HAHKLOTUBBE, DAVIDFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:80CENSUS: 43DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Jasmine LatuTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator does not designate a substitute during absence from facility.
Administrator is not on the premises a sufficient number of hours.
Facility is not training staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/19/2024, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director Jasmine Latu and LPA explained the purpose of the visit.

Regarding the allegation of administrator does not designate a substitute during absence from facility, Reporting Party (RP) stated that this facility currently lacks leadership, and the new Executive Director, left for vacation last week and did not designate someone to cover. RP stated that for about a week this facility has been like a "ghost ship", and that the only staff there right now are the caregivers and the concierge person (and someone in accounting) - so - there is nobody providing managerial oversight and handling complaints or would know what to do "if something comes up".

page 1 of 3
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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 6
Control Number 26-AS-20220718113427
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: SONNET HILL
FACILITY NUMBER: 435202780
VISIT DATE: 12/19/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Marrufo was able to interview nine staff members. All mentioned that if the administrator is not in the building then it will be the other directors or managers on duty who will be in charge. S2 mentioned that they would go to the Memory Care Director (MCD), Marketing Director or Business Office Director. It was communicated to S2 in person who to reach out too. S3 stated that they go to their immediate supervisor. S3 also shared that here (the facility) is like a family, when someone is not here, everyone is working together. S5 said that they have always been good, shared that they have never worked a day when the director wasn’t here. It is always a given that someone is here. S4 mentioned that it was never shared to him/her who was in charge of the whole facility when the administrator is gone but did mention that they go to the MCD.

During the interviews, there were eight residents that were asked. R1 & R2 mentioned that the current administrator stepped up but they don’t remember if it was communicated to them who’s in charge if there is no administrator. R2 also shared that they have never experienced a time when there was no one in charge of the facility. They always get here. R8 said that there was a change in management but doesn’t know their name. R3, R4, R7 said they don’t know who’s in charge because it has never come up. R5 didn’t want to be interviewed. R6 is not able to answer due to cognitive issues.

Based on records review, there were 5 people who has a designation of facility responsibility when Licensee or Administrator is not available. The current administrator was also appointed by the board on July 1, 2022.

Regarding the allegation of Administrator (ADM) is not on the premises a sufficient number of hours.

During the staff member interviews, seven staff members mentioned that they see the administrator every time they work. S1 said that he/she doesn’t know what time the ADM comes in due to the start time, but when S1 comes in the ADM is already in the facility. There are times when S1 leave and ADMs car is still there. ADM is still available on call in the evenings. If there are issues S1 reaches out and ADM always picks up.

page 2 of 3
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 26-AS-20220718113427
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: SONNET HILL
FACILITY NUMBER: 435202780
VISIT DATE: 12/19/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 S2 said that they know ADM works in the mornings. S3 stated that ADMs work schedule is maybe 9 AM until 5 PM. ADM is here almost 5-6 days in a week. I am not completely sure. S4 shared that his/her shifts always used to change. The only time S4 would notice ADM gone would be maybe the weekends, but that was just the weekends. S5 mentioned that ADM is in the facility usually, 9-5. Give or take a few hours. If an emergency or something happens, they are here. When S5 comes here, they are maybe here 30 minutes before.

For the allegation that Facility is not training staff, LPA Marrufo was able to obtain staff training records. 5 staff member have current CPR/AED/ First Aid Training, 6 staff showed 4 hours of Dementia Training.

During the interviews, S1 shared that when he/she first got hired, the training received from the old nurse was not very much I felt like. Now, S1 is doing the training that should have done months ago, which is through Relias. The whole staff is doing that now. S7 mentioned that they have done first aid, dementia training, and fire drill training. S8 stated that they received hands on training by the old nurse. That was mostly hands on and watching videos. This new nurse just left and told us we had to train on Relias on our downtime because we have been pretty busy and haven’t been able to train. We went through 4 hours of med training where we check the meds 3 times and logging it into point click care after we give the medicine. The people who hand out the meds are supposed to use the point click care systems. If a care giver was trained by the nurse, then the care giver is supposed to be able to use the point click care system.

Based on interviews and records review, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed and copy is provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 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
07/18/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220718113427

FACILITY NAME:SONNET HILLFACILITY NUMBER:
435202780
ADMINISTRATOR:HAHKLOTUBBE, DAVIDFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:80CENSUS: 43DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Jasmine LatuTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not maintaining resident medication records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/19/2024, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director Jasmine Latu and LPA explained the purpose of the visit.

Regarding the allegation of Facility is not maintaining resident medication records.

Executive Director (ED) provided documentation to LPA Marrufo showing a resident R1 having a medication log on the Centrally Stored Medication and Destruction Record (CSMDR) through the system that they use which is PointClickCare. ED also explained to LPA Donato that with this system they are also able to electronically request for refill of medications.

As of this report the facility has since changed into a different system.

Based on interviews & records review, the department has determined that the allegation was false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED.

Report is reviewed and copy is provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
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
07/18/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220718113427

FACILITY NAME:SONNET HILLFACILITY NUMBER:
435202780
ADMINISTRATOR:HAHKLOTUBBE, DAVIDFACILITY TYPE:
740
ADDRESS:429 MERIDIAN AVETELEPHONE:
(408) 731-0019
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:80CENSUS: 43DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Jasmine LatuTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident has no appraisal of individual service needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/19/2024, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director (ED) Jasmine Latu and LPA explained the purpose of the visit.

For the allegation of Resident has no appraisal of individual service needs.

LPA Marrufo and LPA Kaur reviewed records 7/12/2022 and it was found out that 7 out of 7 residents did not have a needs and services plan. Current ED mentioned that during this time, the previous ED and Health Services Director (HSD) did not provide any needs and services plan to the residents.

Based on interviews and observations, there is preponderance of evidence to prove the alleged violations did occur; therefore, the allegation is SUBSTANTIATED.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC9099-D for more information.

This report was reviewed a copy of the reports and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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-20220718113427
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: SONNET HILL
FACILITY NUMBER: 435202780
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2024
Section Cited
CCR
87467(a)
1
2
3
4
5
6
7
87467 Resident Participation in Decisionmaking (a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility.
1
2
3
4
5
6
7
Licensee has already updated all needs and services plans of residents when the new ED took over.
8
9
10
11
12
13
14
This was not met as evidenced by: Based on records review, 7 out of 7 resident files reviewed does not have a needs and services plan, which poses an immediate health, safety, or personal rights risk to clients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6