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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202818
Report Date: 09/13/2024
Date Signed: 09/13/2024 12:16:24 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
09/15/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220915105128
FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:SILVA, FLAVIOFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 62DATE:
09/13/2024
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Kippie CastronovoTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility increased resident's fees without proper notice.
INVESTIGATION FINDINGS:
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On 9/13/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director, Kippie Castronovo and explained the purpose of today's visit.

Regarding the allegation that facility increased resident's fees without proper notice, RP alleges that the facility did not adhere to the Admission's Agreement and engaged in a "bait and switch" scheme by increasing R1s fees right after R1 entered the facility, increased the fees without proper notice.

Based on records review, facility did an initial assessment after R1 has moved in. However, there was no written notice given to the responsible party regarding this increase in rate, within 2 business days from this assessment.

Therefore, based on interviews and records review and information collected, the above allegation is
determined to be SUBSTANTIATED. Deficiency of the California Code of Regulations, Title, 22
cited on the LIC9099-D. Failure to correct the deficiency may result in civil penalties.

A copy of this report and the Appeal Rights are provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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 5
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
09/15/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220915105128

FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:SILVA, FLAVIOFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 62DATE:
09/13/2024
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Kippie CastronovoTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Facility charged resident fees for services not provided.
INVESTIGATION FINDINGS:
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On 9/13/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director, Kippie Castronovo and explained the purpose of today's visit.

Regarding the allegation of facility charged resident fees for services not provided, RP stated that in the 1/6/2022 assessment, Facility assessed R1 to require medication repackaging.

Based on records review, LPA reviewed the ledger provided by the facility. Said charges for Medication and Pharmacy points were credited back to R1. There was a credit back on 1/06/2022 and 1/7/2022 for both Pharmacy and Medication respectively. The following months were also credited back, 2/16/2022, 3/20/2022, 5/8/2022 (for the month of April), 5/26/2022 (for the month of May). June and July 2022 was credited back under Care fees.

Based on interviews and records review, the department has determined that the allegation were 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: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/15/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220915105128

FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:SILVA, FLAVIOFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 62DATE:
09/13/2024
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Kippie CastronovoTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
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9
Facility did not notify resident’s physician of a change in condition.
INVESTIGATION FINDINGS:
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On 9/13/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director, Kippie Castronovo and explained the purpose of today's visit.

Regarding the allegation of facility did not notify resident’s physician of a change in condition. Reporting Party (RP) stated that on the residents (R1) assessment and service plan dated 1/06/2022, it documents that R1 is suffering from incontinence. RP has also stated that R1 was able to respond to bodily needs when needed.

Based on records review, it was stated in R1s assessment for 1/6/2022 that there was an occasional incontinent of bladder and/or bowel and occasionally requires assistance. The updated physician’s report was dated 2/10/2022.

LPA interviewed staff members S1 & S2, and it was mentioned that hospice was made aware of the change since R1 was already on hospice, and calls were also made to the physician.

Based on interviews & records review, the department has determined that although the allegation 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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 5
Control Number 26-AS-20220915105128
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: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
09/20/2024
Section Cited
HSC
1569.657(a)
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§1569.657 Rate increase due to change in level of resident care; notice (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.
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Licensee to submit a plan to address the submission of notices to residents/responsible parties if there is any rate change in the level of care. Licensee to submit by POC due date.
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This was not met as evidenced by: Based on records review, the facility did not provide 2 day written notice about detailing the new rate for the charges for the new level of 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: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5