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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202780
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:19:12 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
02/07/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220207152732
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: 46DATE:
01/10/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Dominique FrommoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident was locked in room.
Staff did not administer resident's medication.
Resident left in soiled diaper for an extended period of time.
INVESTIGATION FINDINGS:
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On 1/10/2025, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Health Welness Director (HWD) Dominique Frommo and LPA explained the purpose of the visit.

Regarding the allegation of resident was locked in a room, reporting party (RP) stated that the resident (R1) had taken a rapid decline and was locked in his/her room. Not bolt locked, but R1 can’t move without assistance.

LPA Donato interviewed HWD and it was stated that the rooms are not locked. Staff lock the doors when residents are out on the floor to prevent other residents from roaming inside the rooms. Residents are also able to lock it themselves if they are cognitive enough to do so.

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

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 26-AS-20220207152732
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: 01/10/2025
NARRATIVE
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Regarding the allegation that staff did not administer resident's medication, RP stated that R1 had been given lunch but no lunchtime medication. They had to go around that floor to find someone and they found the floor assistant who had to give my R1 the lunchtime meds at request.

LPA interviewed two staff members. Both S1 & S2 mentioned that residents are given medications on a timeframe of at least 2 hours. S1 explained to LPA that in the morning the med pass happens between 7-9am. Around lunch it happens between 11am-1pm. They give the medication during lunch time. In memory care they start lunch at 11.

Regarding the allegation of resident left in soiled diaper for an extended period of time, RP shared that R1s diaper had not been changed since the night before. RP is not sure the condition R1s diaper, but it was clear R1 hadn’t been changed properly for the morning.

According to S2, they are at least scheduled to do round every 2 hours to check on residents. If in between they notice that residents need changing then they assist the resident. If a resident was left in soiled diapers and the next shift notices it they report it to management so it will be addressed.

Based on interviews, 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 violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

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

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC9099 (FAS) - (06/04)
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