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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202818
Report Date: 08/26/2024
Date Signed: 08/26/2024 12:05:19 PM

Substantiated


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
12/11/2023 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20231211103328
FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:PAULA SPANEKFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 65DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Kippie CastronovoTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff do not respond timely to the residents alerts
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christine Dolores and Grace Donato arrived unannounced to deliver the findings for the above allegation. LPA met with Executive Director, Kippie Castronovo.

On 12/11/2023, the Department received the complaint. On 12/14/2023, the initial complaint investigation was conducted.

The following documents were obtained to include the call alert records in assisted living and memory care from November – December 2023 and staff schedule.

PAGE 1 OF 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
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 8
Control Number 26-AS-20231211103328
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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
VISIT DATE: 08/26/2024
NARRATIVE
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It was alleged that residents in assisted living shared that staff are not responding to their alert calls when they press their pendant. It was alleged that staff respond that they are understaffed. It was also alleged that on 12/10/2023, a resident’s (R5) responsible party pressed the pendant and alert button and did not receive a response.

Based on record review, in November 2023 there were 801 calls with a response time of 10 minutes and more. From 12/01/2023 – 12/13/2023 there were 383 calls with a response time of 10 minutes and more.

Based on record review of the call button log on 12/10/2023 from R5, there was 4 calls with a response time of 10 minutes and more.

10 residents were interviewed. 4 out of 10 residents state that sometimes it takes the staff a long time to respond to their pendant alerts. R1 states that sometimes it takes staff up to 40 minutes to respond. R1 states that it takes the longest in the middle of the day and sometimes in the morning between 7:00am – 8:00am. R2 states the response can take up to 30 minutes. R2 states the response time is slow in the middle of the day. R3 states it takes a “long time” for staff to respond if they are busy, especially at dinner time. R4 states the average wait time is about 30 minutes.

4 out of 4 residents states the facility is understaffed which is the reason they cannot respond timely.

Based on staff interview, it was stated that staff should respond to pendant alerts within 10 minutes.

The Department has investigated the above allegation. Based on interview, record review and observation the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. A deficiency was cited today per California Code of Regulations, Title 22.

This report was reviewed with Executive Director, Kippie Castronovo and a copy of the report and appeal rights were provided. See LIC9099-D.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 26-AS-20231211103328
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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
08/26/2024
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care... This requirement is not met as evidenced by:
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Licensee states they are currently fully staffed. Licensee will submit the staffing schedule for AL and MC to LPA Dolores via email by POC due date.
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Based on interview, record review and observation the licensee did not ensure the staff were sufficient in numbers to respond timely to the resident’s call buttons which poses an immediate health, safety and personal rights risk to persons in care.
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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: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 8
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
12/11/2023 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20231211103328

FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:PAULA SPANEKFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Kippie CastronovoTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Residents food in memory care is always cold
Staff are sleeping while providing care and supervision
Staff are leaving the residents unattended
Staff are not providing a comfortable environment for the residents
Staff are not properly trained on medications
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christine Dolores and Grace Donato arrived unannounced to deliver the findings for the above allegation. LPA met with Executive Director, Kippie Castronovo.

On 12/11/2023, the Department received the complaint. On 12/14/2023, the initial complaint investigation was conducted.

The following documents were obtained to include staff schedule, staff roster, resident roster, all medtech training from 2023, email correspondences, and resident (R1)’s physician’s report, service plan, medication administration record, and progress notes.

It was alleged that the resident’s food in memory care is always cold.
PAGE 1 OF 3.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
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 8
Control Number 26-AS-20231211103328
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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
VISIT DATE: 08/26/2024
NARRATIVE
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7 staff were interviewed. Based on staff interview, 7 out of 7 staff state the residents food comes out warm. 7 out of 7 staff state they have a microwave in memory care and will re-heat the resident’s food if they complain it is cold.

10 residents were interviewed. 10 out of 10 residents state the food comes out warm. 7 out of 10 resident states that staff can warm up their food in the microwave if needed.

On 12/14/2023, LPA Dolores observed the memory care dining room area during lunch time. The food warmer temperature was maintained at 115 degrees Fahrenheit which stored all the residents lunch. The surface of the plate and bowls were observed warm. LPA Dolores observed a microwave in the dining room area. Staff stated they use the microwave in the resident’s complaint that their food is cold.

It was alleged that NOC shift staff are sleeping leaving no staff on the floor to provide care and supervision to the residents.

10 residents were interviewed. 10 out of 10 residents are not aware of any NOC shift staff sleeping during the night. 10 out of 10 residents denied being left unattended where there were no staff to respond.

7 staff members were interviewed. 7 out of 7 staff are not aware of any staff sleeping during their shift. 7 out of 7 staff denied leaving the residents unsupervised.

Based on record review, the facility schedules at least 2 NOC shift care staff in assisted living and memory care daily.

It was alleged that the facility does not provide a comfortable living environment for the residents in memory care because of the family room TV is extremely loud.

5 residents in memory care were interviewed. R5 and R7 states to ask staff to turn down the volume if they TV volume is too loud. R5 and R7 states the staff will turn down the volume. R6 does not think the TV is too loud. PAGE 2 OF 3.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 26-AS-20231211103328
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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
VISIT DATE: 08/26/2024
NARRATIVE
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7 staff were interviewed. 7 out of 7 staff state the volume of the TV in memory care is not too loud. S1 and S6 states they have residents who complain when it’s loud and they’ll put it down, like R7. S1 states the residents are verbal about the TV being too loud. S3 states that sometimes the volume gets too loud during commercials, and they’ll lower or change it. S5 states to have come to the facility unannounced during the PM time and did not observe the TV was loud. S6 denied the TV being too loud where they can’t hear.

On 12/14/2023, LPA Dolores observed the dining room and activities area in memory care. LPA observed the TV was on and the volume was loud but none of the residents were complaining. LPA observed that although the TV was loud, LPA was able to hear surrounding noise to include staff to resident conversations.

It was alleged that staff are not properly trained on medication because the MedTech’s do not have knowledge on medications and their side effects.

Based on record review, MedTechs are provided with 24 hours of initial medication training to include hands-on shadowing training and topics on medication management, medication orders and/ working with pharmacies, medications and documentation's, assistance with medication administration, side effects, adverse reactions, and medication errors, and understanding California medication regulations. 3 MedTech’s in memory care were provided at least 24 hours of initial training on medication.

Based on recover review, staff were provided in-service training on medications on 12/01/2022, 01/18/2023, 05/11/2023, 05/23/2023, and 11/02/2023.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unsubstantiated. An unsubstantiated finding indicates that although the allegations may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Kippie Castronovo and a copy of the report was provided. PAGE 3 OF 3.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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
12/11/2023 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20231211103328

FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:PAULA SPANEKFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: DATE:
08/26/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Kippie CastronovoTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff is performing duties without an appropriate skilled professional present
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christine Dolores and Grace Donato arrived unannounced to deliver the findings for the above allegation. LPA met with Executive Director, Kippie Castronovo.

On 12/11/2023, the Department received the complaint. On 12/14/2023, the initial complaint investigation was conducted.

The following documents were obtained to include S8’s job description.

It was alleged that a staff (S8) is performing duties without an appropriate skilled professional present. It was alleged that the health service director was administering residents flu shots in October 2023. PAGE 1 OF 2.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 26-AS-20231211103328
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: OAKMONT OF SAN JOSE
FACILITY NUMBER: 435202818
VISIT DATE: 08/26/2024
NARRATIVE
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It was alleged that a staff (S8) is performing duties without an appropriate skilled professional present. It was alleged that the health service director was administering residents flu shots in October 2023.

Based on staff interview, S8 states they contract with a third-party vendor to administer the flu shots. S8 denied administering any flu shots to residents in October 2023. S8 states he/she was only helping with the paperwork but denied injecting any flu shots.

The Executive Director stated that S8 does have an LVN license but does not perform any LVN duties. S8 job duties includes care plan assessments and change of condition assessment. The ED stated that the facility is not a medical facility and are not required to have any doctor’s or registered nurses.

The Department has investigated the above allegation. Based on interviews, record review and observation the above allegations is unfounded meaning the allegations is false, could not have happened, and/or is without a reasonable basis.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Kippie Castronovo and a copy of the report was provided.

PAGE 2 OF 2.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC9099 (FAS) - (06/04)
Page: 8 of 8