435202895-1-23-2026-26-AS-RMAO-DR32LV-20260206163011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202895
Report Date: 01/23/2026
Date Signed: 01/23/2026 11:53:59 AM

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
08/12/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250812163239

FACILITY NAME:	MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE		FACILITY NUMBER:	435202895
ADMINISTRATOR:	HALL, STEPHANIE		FACILITY TYPE:	740
ADDRESS:	1380 S DEANZA BLVD		TELEPHONE:	(669) 295-6500
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	149	CENSUS: 87	DATE:	01/23/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Wellness Director Trisa Cysewski		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff who is not a skilled medical professional performed glucose testing
Staff did not dispose expired medications per facility procedures.
Licensee/Administrator is not completing the required staff training hours per Title 22 regulations.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Wellness Director Trisa Cysewski

On August 12, 2025, the Department received a complaint alleging Staff who is not a skilled medical professional performed glucose testing. It has been alleged an unskilled staff preformed glucose testing for resident R1.

On August 21, 2025, LPA Steve Chang interviewed Executive Director (ED) Stephanie Hall. ED stated the facility does not provide the install service of sensor or blood sugar monitoring device for residents.

LPA Chang interviewed Wellness Director (WD) Angel Bustos. WD stated the facility does not provide the service to install a censor or blood sugar monitoring device in resident's body.
Page 1 Out of 6

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

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 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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LPA Chang interviewed R1. R1 stated he/she does not have insulin injections. R1 stated every 2 weeks the the blood sugar monitoring device is switched from his/her right/left arm to the other arm.

On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 6 Out of 6 (S1-S6) staff stated the only people who can preform glucose testing is the nurse or the resident themselves. 6 Out of 6staff (S1-S6) stated he/she hasn’t seen any unqualified staff administering glucose testing.

On December 26, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she has not observed anyone administer insulin or do glucose testing. S8 stated he/she doesn’t handle residents medications and isn’t aware regarding insulin or glucose testing.

On December 26, 2025, LPA Manuel Monter interviewed Residents R1. R1 stated he/she has a continuous glucose monitor, which sends the information to the app. R1 stated he/she doesn’t need to do any finger pricks or any form of injections to monitor his/her glucose. R1 stated he/she also takes medication tablets for his/her diabetes. R1 stated his/her family member is the person who switches the censors for him/her blood sugar monitor every 2 weeks.

On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 3 Out of 5 staff (S8, S11, S12) stated they doesn’t handle residents medications and doesn’t know about residents insulin or glucose testing. S9 stated only a nurse can administer insulin or preform glucose testing. S10 stated the resident’s family does the switching of the glucose sensors. S10 stated he/she only marks it on the MAR.

On January 6, 2025, LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated at the facility, they do not administer residents insulin. WD stated facility staff do not do any injections of any kind, and only the nurse can do this. WD stated she initially put the sensor for resident R1. WD stated R1’s family member was changing the sensor. WD stated the family changes the sensor, while the medtech gives the family the new sensor and marks it on the MAR.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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On January 8, 2026, LPA Manuel Monter interviewed Administrator (ADM) April Princesa. ADM stated regarding the changing of R1’s glucose testing sensors: R1’s family member changes R1’s sensors every 2 weeks. ADM stated the med tech will provide the new censor to R1’s Family member and will observe the changing of the censors and will mark it on the MAR. ADM stated medtechs check the blood sugar for R1 by putting the phone on to check the blood sugar, via the censor.

On January 13, 2026, LPA Manuel Monter interviewed R1’s Family Member (FM). FM stated he/she changes R1’s glucose testing censors. FM stated the staff at the assisting living facility don’t do it. FM stated he/she has been changing R1’s sensor for the last 3 months. FM stated there used to be a nurse at the facility that used to change it, once he/she left, he/she needed to do it.

The Department reviewed R1’s Physician’s report, dated March 4, 2025. The Physician’s report states R1 is not able to administer his/her own medications

The Department reviewed R1's Individual Service Plan, dated October 29, 2024. The plan states the facility staff will assist R1 with diabetes treatment plan.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, 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.

Staff did not dispose expired medications per facility procedures.

On August 12, 2025, the Department received a complaint alleging Staff did not dispose expired medications per facility procedures. It has been alleged expired medication are being kept in the 4th floor med room.

On August 21, 2025, LPA Steve Chang toured facility med room and med carts in the 2nd floor, 3rd floor and 4th floor. LPA did not observe any expired medications. LPA also inspected medication in refrigerator of med room and did not observe any expired medications. Page 3 Out of 6

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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LPA Chang interviewed Memory Care Coordinator (MC) Diana Sala. MC stated she maintains the medications destruction documents. MC showed and provided the medication destruction log. MC showed the medication destruction box in Wellness direction office.

LPA Chang interviewed Assisted Living Coordinator (ALC), Jacque Barcellano. ALC stated company SHARPS helps the facility to destroy the expired medications. ALC stated there are 2 medication destruction box in Wellness director office and assisted living director office. ALC provided the medication destruction log documents.

On August 21, 2025, LPA Chang made the following observations: LPA to toured the med room and med carts in 2nd, 3rd and 4th floor. LPA checked the medications, LPA did not see the expired medications. LPA observed all the med carts were locked and Med room was locked. LPA checked the medications in refrigerator of Med room. LPA did not see the expired medications inside.

On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 5 Out of 6 Staff (S1-S4, S6) stated they are not aware of the details regarding expired medications. 5 Out of 6 staff (S1-S3, S5) stated expired medications are locked in the wellness directors office in the first floor for destruction. Staff S5 stated expired medications are destroyed by the nurse.

On December 17, 2025, LPA Manuel Monter toured the fourth floor med room. LPA observed the refrigerator in the med room, which contained medications that were not expired.

On December 24, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she isn’t aware of the expired medication procedures.

On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 3 Out of 5 staff (S8, S11, S12) stated they do not handle residents medications and are not aware of the facility’s expired medication protocols. 2 Out of 5 staff (S9-S10) stated when there is expired medications, Medtech’s are supposed to take them to the wellness directors office on the first floor for destruction.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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On January 6, 2026, LPA Manuel Monter interviewed Wellness Director (WD), Angel Bustos. WD stated when there is an expired medication, Medtech’s take the expired medications to her office (Wellness directors office) for destruction, when in two members will destroy the medication in the presence of each other and recorded.

The Department reviewed the facility’s Medication Destruction Policy, dated September 2024. The policy states discontinued, unused or expired medications will be destroyed by the community. Until destroyed, medications will kept secure in the medication room. If medications may be returned to the pharmacy for destruction for credit, follow the pharmacy policy on returns. If medications are destroyed at the community: two team members will destroy the medications. Two team members will perform the destruction in the presence of each other. Medications will destroyed either utilizing the drug buster disposal system or medsafe basic / medsafe.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, 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.

Licensee/Administrator is not completing the required staff training hours per Title 22 regulations.

On August 12, 2025, the Department received a complaint alleging Licensee/Administrator is not completing the required staff training hours per Title 22 regulations.

On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 6 Out of 6 (S1-S6) staff stated staff have been provided their required training. 6 Out of 6 (S1-S6) Staff stated they are not aware of any staff who were not provided training.

On December 17, 2025, LPA Manuel Monter randomly reviewed 5 staff records. LPA observed staff training records to be complete.

On December 24, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she was provided his/her required training. S7 stated he/she is not aware of any staff that were not provided their required training. Page 5 Out of 6

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 4 out of 5 staff (S8, S9, S10, S12) stated staff have been provided their required training and they are not aware of any staff who were not provided with their training. S11 stated he/she was provided with training and was/is shadowing and learning his/her position.

On January 6, 2026 LPA Manuel Monter interviewed Memory Care Director (MC) Diana Salah. MC stated staff have been provided their required training and she is not aware of any staff who were not provided with their training.

On January 23, 2026, LPA Manuel Monter randomly reviewed 4 staff training records. LPA observed staff training records to be complete.

LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated staff have been provided their required training and she is not aware of any staff who were not provided with their training.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, 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.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 11

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
08/12/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250812163239

FACILITY NAME:	MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE		FACILITY NUMBER:	435202895
ADMINISTRATOR:	HALL, STEPHANIE		FACILITY TYPE:	740
ADDRESS:	1380 S DEANZA BLVD		TELEPHONE:	(669) 295-6500
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	149	CENSUS: 87	DATE:	01/23/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Wellness Director Trisa Cysewski		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Residents are not provided good quality food
Staff is not meeting residents' needs due to lack of staffing

INVESTIGATION FINDINGS:

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On August 12, 2025, the Department received a complaint alleging Residents are not provided good quality food.

On October 2, 2025, LPA Steve Chang interviewed Residents R2- R9. Residents 6 Out of 8 Residents (R2, R3, R5, R6, R7, R9) stated the facility food is good and they have no complaints. 2 Out of 8 Residents (R4 and R9) interviewed stated the facility food is fair; being not too good and/or not too bad.

On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 6 Out of 6 staff (S1-S6) stated they have never seen residents served inedible food. 6 Out of 6 staff (S1-S6) stated they have not seen residents served food that was under cooked. 6 Out of 6 staff (S1-S6) stated they have not seen residents served food that was cold or too hot.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

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 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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LPA Monter interviewed residents R10-R13. Resident R10 did not respond to questions posed by LPA and was unable to provide any relevant information due to neurocognitive disorder. Resident R11 stated he/she likes the food the facility makes. R11 stated there hasn’t been a time when a resident was served food that was under cooked, boiling hot, or cold. 2 Out of 4 Residents (R12 & R13) stated the food the facility makes is always overcooked and has never been undercooked. 2 Out of 4 Residents (R12 & R13) stated the food always comes out cold.

On December 26, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she hasn’t observed food being served to residents during his/her shift. S7 stated he/she isn’t aware of any issues.

On December 26, 2025, LPA Manuel Monter interviewed Residents R1, R3, R4, R8, R14- R17. 6 Out of 8 Residents (R1, R3, R4, R8, R14, R15) stated the food served at the facility is adequate. R17 stated the food the facility makes is good. R16 stated he/she doesn’t like the food served at the facility. 7 Out of 8 residents (R1, R3, R4, R8, R14, R15, R17) stated he/she has never been served food that was cold or undercooked. 1 Out of 8 Residents (R16) stated meals are served cold to the residents at least once a week. 1 Out of 8 Residents (R16) stated he/she was served undercooked salmon once but doesn’t remember the date.

On December 26, 2025, LPA Manuel Monter interviewed Kitchen Staff K1-K3. 3 Out of 3 Kitchen Staff (K1-K3) interviewed stated they have not seen any resident being served food that was undercooked or served meals that were cold.

On December January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 2 Out of 5 Staff ( S11) stated meals are not served during their shift and isn’t aware of any issues regarding residents’ meals. 4 Out of 5 Staff (S8- S10, S12) stated they have not seen any resident being served food that was undercooked or served meals that were cold or too hot.

Page 2 Out of 5

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 8 of 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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On January 6, 2026 LPA Manuel Monter interviewed Memory Care Director (MC) Diana Salah. MC stated he/she has never seen residents served food that was under cooked (meat / vegetables). MC stated she has never seen food served to resident cold or too hot. MC stated food is brought to the memory care unit from a cart. MC stated the meals are on hot plates then given to residents, warm.

LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated he/she has never seen residents served food that was under cooked (meat / vegetables). WD stated she has never seen food served to resident cold or too hot.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

Staff is not meeting residents' needs due to lack of staffing.

On August 12, 2025, the Department received a complaint alleging Staff is not meeting residents' needs due to lack of staffing.

On August 21, 2025, LPA Steve Chang interviewed Executive Director (ED) Stephanie Hall. ED stated for AM shift memory care unit, there are 5 caregivers and 1 Med tech for 34 residents. ED stated for AM shift assist living unit, there are 2 caregivers and 1 med tech for 26 assisted living residents and 24 independent residents. ED stated there is a nurse for AM shift. ED stated PM shift is the same as AM shift. ED stated for NOC shift, there are 2 caregivers for memory care unit and one caregivers for Assist living unit. 1 med tech for both AL and MC unit. ED stated nurse is on call for NOC shift.

On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 5 Out of 6 staff (S1, S2 S4 – S6) stated there is enough staff to meet the needs of the residents. 1 Out of 6 Staff (S3) stated there isn’t enough staff.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 9 of 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

NARRATIVE

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LPA Monter interviewed residents R10-R13. Resident R10 did not respond to questions posed by LPA and was unable to provide any relevant information due to neurocognitive disorder. R11 stated there is enough staff to meet the needs of the residents. 2 Out of 4 residents (R12-R13) stated there is not enough staff. 2 Out of 4 residents (R12-R13) stated the issue is that there has been 3 different administrators in the past year and a lot of staff turn over.

On December 17, 2025, LPA Manuel Monter toured the facility and toured resident bedrooms: 247, 222, 223, 224, 227, 225, 219, 221, 217, 215, 211, 228, 209, 207, 205, 203, 201, 230, 231, 235, 245, 237, 239, 244, 241, 243, 242, 249, 255, 251, 253, 1133, 3124. While touring these bedrooms, LPA observed the bedrooms as clean and in good repair. While touring the memory care LPA did not observe residents in a soiled / disheveled state.

On December 26, 2025, LPA Manuel Monter interviewed staff S7. S7 stated there isn’t enough staff to meet the needs of the residents. S7 stated there are many residents and its difficult to assist so many residents, with only 2 care givers and a medtech during the Night shift.

On December 26, 2025, LPA Manuel Monter randomly tested a residents pendant to assess the facility’s response time. Facility staff responded the pendant in 5 minutes and 53 seconds.

On December 26, 2025, LPA Manuel Monter interviewed Residents R1, R3, R4, R8, R14- R17. 3 out of 8 residents (R1,R3, R16) stated there is not enough staff to meet the needs of the residents. R1 stated he/she has pressed his/her pendant and the staff can take up to 20 minutes to respond. R1 R3 R16 stated due to the turn over there may not be enough staff to respond quickly to residents needs. 5 out of 8 Residents (R4, R8, R14, R15, R17) stated there is enough staff to meet the needs of the residents.

On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 3 out of 5 staff (S8, S9, S11) stated there is enough staff to meet the needs of the residents. 2 Out of 5 staff (S10, S12) stated there isn’t enough staff to meet the needs of residents in the facility. S10 stated there is a lot of call outs in the memory care unit and it is difficult for the facility to have a full staff to meet the needs of the residents in the memory care unit. S12 stated the facility memory care unit is always short staffed. S12 stated staff are constantly quitting and the memory care unit is so short staffed, they always need coverage assistance.
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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 11 of 11

Control Number 26-AS-20250812163239

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: MORNINGSTAR ASSISTED LIVING OF WEST SAN JOSE	FACILITY NUMBER: 435202895
	VISIT DATE: 01/23/2026

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On January 6, 2026, LPA Manuel Monter interviewed Memory Care Director (MC) Diana Salah. MC stated there is enough staff to meet the needs of the residents. MC stated on the instances where staff call out sick, she and the assisted living coordinator will help cover if needed.

LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated there is enough staff to meet the needs of the residents. WD stated on the instances where staff call out sick, she and the Memory Care Director will help cover if needed.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

Page 5 Out of 5. END OF REPORT

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 10 of 11