435202937-3-5-2026-26-AS-RMAO-DS4QR2-20260312122311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202937
Report Date: 03/05/2026
Date Signed: 03/05/2026 10:49:34 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
07/07/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250707122429

FACILITY NAME:	WATERMARK AT SAN JOSE, THE		FACILITY NUMBER:	435202937
ADMINISTRATOR:	KELLIE SHEARER		FACILITY TYPE:	740
ADDRESS:	1017 S BASCOM AVE		TELEPHONE:	(520) 797-4000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	205	CENSUS:	DATE:	03/05/2026
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Administrator Jolie Higgins		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not prevent a resident from wandering
Staff mishandled the residents personal belongings

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 Administrator Jolie Higgins

On July 7, 2025 the Department received a complaint alleging Staff did not prevent a resident from wandering.

On July 14, 2025, Licensing Program Analyst (LPA) Steve Chang interviewed Memory Care Director Daleht Miranda, referred to as S1. S1 stated around March 2025, families had keys to enter and exit the memory care unit and that caused problem. S1 stated because family does not know all the residents, it creates a possibility of a resident following a family exit memory care unit. S1 stated in March or February 2025, resident R1 exited the memory care unit but was stopped by the front desk staff.

Page 1 Out of 6

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On October 3, 2025, LPA Steve Chang interviewed Administrator (ADM) Kellie Shearer. ADM stated resident R1 followed other families who were exiting the memory care unit and took elevator to the lobby area. R1 was found by staff in the lobby area on March 12, 2025 around 9:05PM. ADM stated after the incident, the facility put doorbell at the memory care unit entrance door/exit door and the facility members need to buzz in and buzz out of the memory care unit. ADM stated staff need to open and close the exit door of the memory care unit. ADM stated the facility checked R1 after the incident and did not found any injury.

On January 23, 2026, LPA Manuel Monter interviewed Staff S2-S6. 3 Out of 5 staff (S2, S3 S5) stated residents have attempted to elope from the memory care unit, but their attempts were thwarted by staff who intervened. S4 stated he/she is not aware of residents eloping from the memory care unit. S6 stated R1 did wander out of the memory care unit. S6 stated R1 managed to wander to the front door area, but the front desk was able to redirect R1 back to the memory care unit.

S6 stated R1 was able to get down, by following a family down the elevator. S6 stated this only happened once. S6 stated family’s used to have the card/fobs to leave the facility. S6 stated after R1 was able to get down, they changed the procedures. S6 stated family now has to ring the door bell to enter and needs to ask for staff assistance to exit.

On January 23, 2026, LPA Manuel Monter interviewed Assisted Living Director (ALD) Mayte Calderon. ALD stated she isn’t aware of any residents eloping from the facility. ALD stated residents have attempted to elope, but staff are able to redirect the residents who try to elope.

On February 5, 2026, LPA Manuel Monter interviewed Community Life Director (CLD) Barbra Fleig. CLD stated she is not aware of R1 eloping from the memory care unit. CLD state other residents have attempted to leave the memory care unit, but staff intervenes and returns the residents back to the memory care unit.

On February 5 & 9, 2026, LPA Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1 & Staff S7-S11. S1 stated she is aware when R1 had been found in the lobby by the front desk staff and redirect. 4 Out of 6 staff (S7-S10) stated they are not aware of any instance where a resident left the memory care unassisted and went to the first floor unassisted. S11 stated he/she is aware of an instance where a resident managed wander to the first floor but isn’t aware of the details. Page 2 Out of 6

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On February 11, 2026, LPA Manuel Monter interviewed Executive Director (ED) Brenda Ritter. ED stated she isn’t aware of any instance of a memory care resident wandered down to the first floor without supervision.

On February 12 and 25, 2026, LPA Manuel Monter interviewed staff S12-S14. 3 Out of 3 staff (S12-S14) acknowledged that R1 was able to leave the memory care unit unassisted.

The Department reviewed R1's progress notes. Progress note dated March 12, 2025 states, R1 is doing well after elopement. R1 did not him/herself, no injuries noted. R1 stated he/she was accompanied by a woman and that all he/she did was push buttons and stepped foot into the elevator. R1 went to receptionist and concierge alerted nurses.

Based on the totality of this investigation, R1 did leave the memory care unit unassisted and was on the first floor of the facility. Shortly after, R1 was found by the front desk staff, who re-directed R1 back to the memory care unit. Since the first floor is part of the facility grounds, R1 did not elope from the facility. Furthermore, R1 did not sustain any injuries and the facility implemented a change in policy, to prevent other potential wandering incidents.

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 mishandled the residents personal belongings.

On July 7, 2025 the Department received a complaint alleging Staff mishandled the residents personal belongings.

On July 14, 2025, LPA Steve Chang interviewed Administrator (ADM) Kellie Shearer. ADM stated the facility policy is: if the facility receives a report of lost item from resident/family, the facility will ask if they want to report to Police Department. If yes, then the facility will report to the police. ADM stated the facility will help residents to search for the lost items. ADM stated if the value is more than $100, the facility will report incident to licensing. Page 3 Out of 6

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 16

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
07/07/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250707122429

FACILITY NAME:	WATERMARK AT SAN JOSE, THE		FACILITY NUMBER:	435202937
ADMINISTRATOR:	KELLIE SHEARER		FACILITY TYPE:	740
ADDRESS:	1017 S BASCOM AVE		TELEPHONE:	(520) 797-4000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	205	CENSUS:	DATE:	03/05/2026
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Administrator Jolie Higgens		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not provide an authorized representative the admission agreement
Staff did not provide an authorized representative access to a resident's records
Staff did not follow a resident's dietary needs
Staff do not have planned activities
Staff mishandled the residents medications.

INVESTIGATION FINDINGS:

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Staff did not provide an authorized representative the admission agreement. / Staff did not provide an authorized representative access to a resident's records.

On July 7, 2025 the Department received a complaint alleging Staff did not provide an authorized representative the admission agreement and Staff did not provide an authorized representative access to a resident's records.

On July 12, 2025, Licensing Program Analyst Steve Chang interviewed Witness W1. W1 stated, the facility provided the contract of admission agreement for him/her to review and for signature but he/she never received a copy of the admission agreement. W1 stated he/she requested a copy of R1's medication list and some medical documents but the facility provided these documents he/she requested.
Page 1 Out of 10

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On July 14, 2025, Licensing Program Analyst Steve Chang interviewed Administrator (ADM) Kellie Shearer. ADM stated every resident has Admission Agreement prior to moving in the facility. ADM stated only resident's POA can access resident's medical document. ADM stated resident POA need to submit a request in writing to access resident's medical records, and she needs to submit to corporate to approve.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed Staff S6. S6 stated he/she is aware of R1’s family member requesting documents from the facility. S6 stated he/she isn’t aware of what documents were requested. S6 stated when documents are requested, there is a process that needs to be followed, which takes a few days to process. S6 stated R1’s family member did get the documents he/she requested.

On February 5, 2026, Licensing Program Analyst Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1. S1 stated if a family member requests an assessment or service plan, they can print. S1 stated R1’s family member did ask for documents and he/she did receive them at the time.

On February 11, 2026, Licensing Program Analyst Manuel Monter interviewed Executive Director (ED) Brenda Ritter. ED stated regarding document requests from residents responsible parties: the facility will provide said documents if requested. ED stated for certain documents, the facility can provide a copy the same day. ED stated for more medical documents, there is a process that needs to be followed. ED stated they would need to fill out a medical request form. ED stated this would typically take a couple days.

On February 17 & 25, 2026, Licensing Program Analyst Manuel Monter interviewed staff S12. S12 stated R1’s family member didn’t want to speak to him/her. S12 stated R1's family member only spoke with the administrator. S12 stated R1's family member did request documents. S12 stated he/she is aware that the ADM provided the requested documents. S13 stated he/she does remember R1’s FM requesting a copy of the MAR and some documents regarding medications. S13 stated he/she doesn’t remember what had happened with those requests.

Staff S14 stated he/she does remember the back and forth from R1’s FM requesting documents. S14 stated he/she does remember providing said documents to R1’s FM. S14 stated he/she provided to him/her via physical paper in person. Page 2 Out of 10

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On February 25, 2026, LPA Manuel Monter interviewed Former Administrator, (ADM) Kellie Shearer. ADM stated she does remember when R1’s FM had requested documents like the MAR and admission agreement. ADM stated S14 provided said documents. ADM stated she doesn’t know if the documents were provided in paper or email. ADM stated she doesn’t remember the details but reiterated but the documents were given.

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 did not follow a resident's dietary needs

On July 7, 2025 the Department received a complaint alleging Staff did not follow a resident's dietary needs

On July 12, 2025, Licensing Program Analyst Steve Chang interviewed Witness W1. W1 stated, he/she requested the facility not to give R1 milk, but the facility did not follow. W1 stated R1 does not have a doctors order for this dietary restriction.

On July 14 and October 3, 2025, Licensing Program Analyst Steve Chang Administrator (ADM) Kellie Shearer. ADM stated if there is a physician order, then the facility will follow. ADM stated R1 does not have a special diet and does not have a doctors order for a restricted diet. ADM stated R1 does not have a doctors order not to give milk to R1.

On January 20, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she doesn’t think R1 had nondairy dietary restriction noted on R1’s physicians report. W1 stated he/she doesn’t know if it was noted on R1’s care plan. W1 stated he/she did state this food preference verbally to the administrator.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On January 23, 2026, LPA Manuel Monter interviewed Staff S2-S6. 4 Out of 5 staff (S2, S3, S4, S6) stated they are not aware of any instance where a resident was provided food that conflicted with a documented dietary restriction or preference. S5 stated he/she has seen staff serve a resident with a gluten dietary restriction, gluten. S5 stated when this occurred, he/she told that staff member not to serve that food. S5 stated he/she doesn’t recall when this occurred.

On January 23, 2026, LPA Manuel Monter interviewed Assisted Living Director (ALD) Mayte Calderon. ALD stated the kitchen staff are aware of residents personal choices when it comes to food and their restricted diets and food they are allergic to. ALD stated she has not seen residents being served food that they were restricted from having.

On January 23, 2026, LPA Manuel Monter interviewed residents R14-R18. 4 Out of 5 staff (R14-R17) stated they don’t have a special diet. Resident R18 was unable to provide any relevant information due to neurocognitive disorder.

On February 5, 2026, LPA Manuel Monter interviewed Community Life Director (CLD) Barbra Fleig. CLD stated the dinning staff is aware of what food each resident can eat. CLD stated he/she isn’t aware of any instance where a resident was served food there were not able to eat.

On February 5, 2026, LPA Manuel Monter interviewed Health and Wellness Director (HW) Baneen Amiri. HW stated residents diet restrictions are based on doctors orders. HW stated they can also enter the residents preferences into their system, so the people who make the meals are aware. HW stated she isn’t aware of any issues regarding residents being served meals they are not supposed to get.

On February 5 & 9, 2026, LPA Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1 & Staff S7-S11. 5 Out of 6 staff (S1, S7-S10) stated they are not aware of any instance where a resident was provided food that conflicted with a documented dietary restriction or preference. S11 stated residents don’t eat meals during his/her shift.

On February 11, 2026, Licensing Program Analyst Manuel Monter interviewed residents R5, R6, R19-R22. 6 Out of 6 residents (R5, R6, R19-R22) stated they don’t have any dietary restrictions. Page 4 Out of 10

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On February 11, 2026, Licensing Program Analyst Manuel Monter interviewed Executive Director (ED) Brenda Ritter. ED stated the facility and kitchen staff have diet cards for all residents: regarding their dietary restrictions or food preferences. ED stated the staff in the memory care unit, who serve the residents food also know who has dietary restrictions. ED stated she isn’t aware of any instance where a resident was served food that was on their dietary restriction list.

On February 17 & 25, 2026, Licensing Program Analyst Manuel Monter interviewed staff S12-S14. S12 stated he/she is aware of an instance where a resident with a restricted diet was given food they were not supposed to have. S12 stated resident has a gluten restriction. S12 stated when this resident first moved in, it was difficult for staff to remember not to give that resident gluten. S12 stated he/she knows this occurred but cannot remember the details of when this occurred. Staff S13 and S14 stated they are not aware of any instance were a resident was given a meal that conflicted with their dietary restrictions/preferences.

On February 25, 2026, LPA Manuel Monter interviewed Former Administrator, (ADM) Kellie Shearer. ADM stated if a resident has a dietary restrictions, then the doctor will put in an order. ADM stated she doesn’t remember if R1 had a dietary restriction. ADM stated if R1 did have one, it would be listed in the residents file. ADM stated there hasn’t been a time when a resident was given a meal that conflicted with their dietary restrictions/preferences.

The Department reviewed R1’s Care Evaluation, dated July 6, 2025. Under Dietary, the evaluation states staff will assist with low/non-fat milk or alternative diary intake.

The Department reviewed R1's Service plan dated, July 14, 2025. Under dietary, the service plan states R1 can be provided low/non-fat milk or alternative dairy.

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 10

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 8 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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Staff do not have planned activities

On July 7, 2025 the Department received a complaint alleging Staff do not have planned activities.

On July 14, 2025, Licensing Program Analyst Steve Chang interviewed Administrator (ADM) Kellie Shearer. ADM stated the facility has Assistant Living unit and Memory Care unit activities schedules. ADM stated the Memory care unit has the screen to displaying the activities schedule. ADM stated residents of Memory care unit participate in the activities more than 90%.

LPA Steve Chang interviewed Community Life Director (CLD) Barbara Fleig. CLD stated the facility has different activities for Assist Living Unit and Memory Care Unit every day. CLD stated the facility has special event each week for everyone. CLD stated the activity schedules are shown on several screens at each floor including Assistant Living unit and Memory Care Unit. CLD stated for memory care unit around 90% residents participate in the activity.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed Staff S2-S6. 5 Out of 5 staff (S2-S6) stated they are not aware of any instance when residents were not provided activities.

On January 23, 2026, LPA Monter interviewed Assisted Living Director (ALD) Mayte Calderon. ALD stated the memory care unit does have activities. ALD stated they have live music, daily chronical, outings, scenic drives, (simple) book club. ALD stated she isn’t aware of anytime when residents were not provided activities.

On January 23, 2026, LPA Manuel Monter interviewed residents R14-R18. 4 Out of 5 staff (R14-R17) stated the facility is providing activities to residents. Resident R18 was unable to provide any relevant information due to neurocognitive disorder.

On February 5, 2026, Licensing Program Analyst Manuel Monter interviewed Community Life Director (CLD) Barbra Fleig. CLD stated the facility does have activities. CLD activities might include karaoke, daily chronical, puzzles, exercise at 10am, a brain game at 10:30. CLD stated on Wednesdays the facility has an entertainer come in. CLD stated they also have yard games, when the weather allows it. CLD stated they have different activities everyday and its listed on their activity schedule. CLD stated there hasn’t been a time when there wasn’t any activities in the memory care unit. Page 6 Out of 10

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 9 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On February 5 & 9, 2026, Licensing Program Analyst Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1 & Staff S7-S11. 4 Out of 6 staff (S1, S7, S9, S10) stated they are not aware of any instance when residents were not provided activities. S8 stated he/she believes there was some issues with staffing, which caused issues with the activities. S8 stated this occurred in the beginning, over a year ago. S8 stated he/she can’t provide specific examples since it was over a year ago. S11 stated they don’t conduct activities during his/her shift.

On February 11, 2026, Licensing Program Analyst Manuel Monter interviewed residents R5, R6, R19-R22. 6 Out of 6 residents (R5, R6, R19-R22) stated the facility provides activities and there hasn’t been a time when the facility didn’t have activities.

On February 11, 2026, Licensing Program Analyst Manuel Monter interviewed Executive Director (ED) Brenda Ritter. ED stated the facility has a large variety of activities. ED stated they have their Calendar showing what activities are available for that month. ED Stated they also try to emphasize having different activities. ED stated she isn’t aware of any instance where the facility did not provide any activities

On February 17 and 25, 2026, Licensing Program Analyst Manuel Monter interviewed staff S12-S14. 2 Out of 3 staff (S12, S13) stated there hasn’t been an instance where no activities were conducted. S14 stated he/she is aware of there being possible issues with the activities in terms of staffing when the facility first opened, S14 stated this was only what he/she heard and can’t remember the details.

The Department reviewed R1's Activity Participation Log, dated February 19, 2025 - July 30, 2025. Based on a review, R1 participated in a variety of activities such as but not limited to: giant yahtzee, movie atinee, upper body blast, brain games, slow flow yoga, bingo, joyful movement cardio, karaoke, jeopardy, seated stretching, indoor bowling, Sunday sounds with Jenna, virtual church service with Joel Olsteen, and balloon volleyball.

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 7 Out of 10

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 10 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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Staff mishandled the residents medications

On July 7, 2025 the Department received a complaint alleging Staff mishandled the residents medications.

On July 12, 2025, Licensing Program Analyst Steve Chang interviewed Witness W1. W1 stated R1’s doctor prescribed medication M1, but the facility did not administer to R1. W1 stated the facility administered M1 to R1 the next day after he/she found the facility did not administer M1 to R1.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed Staff S2-S6. 5 Out of 5 Staff (S2-S6) stated they are not aware of any issues regarding residents medications.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed Assisted Living Director (ALD) Mayte Calderon. ALD stated he/she isn’t aware of any issues regarding residents medications.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed residents R14-R18. 4 Out of 5 staff (R14-R17) stated they have not had any issues regarding their medication. Resident R18 was unable to provide any relevant information due to neurocognitive disorder.

On February 5, 2026, Licensing Program Analyst Manuel Monter interviewed Community Life Director (CLD) Barbra Fleig. CLD stated she is not aware of any issues regarding residents medications.

On February 5, 2026, LPA Manuel Monter interviewed Health and Wellness Director (HW) Baneen Amiri. HW stated during her time working at the facility, she hasn’t observed or been informed about any issues regarding medications. LPA showed HW R1’s MAR during interview. HW stated she can’t explain why there are blank spots on R1’s MAR.

Page 8 Out of 10.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 11 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On February 5 & 9, 2026, Licensing Program Analyst Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1 & Staff S7-S11. S1 stated there have been times when there was medication errors. S1 stated it has been a long time ago. S1 stated regarding R1’s medication, she remembers there was an issue, regarding R1’s MAR for medication M1. S1 stated there were a couple of spots that were not signed. 3 Out of 6 Staff (S7, S8, S11) stated he/she is not aware of any issues regarding residents medications. 2 Out of 6 staff (S9, S10) stated on at least 2 occasions they have observed unsecured medications tablets in the dinning room or residents bedrooms.

On February 11, 2026, Licensing Program Analyst Manuel Monter interviewed residents R5, R6, R19-R22. 6 Out of 6 residents (R5, R6, R19-R22) stated they get assistance with their medication administration and have not had any issues with their medications.

On February 11, 2026, Licensing Program Analyst Manuel Monter interviewed Executive Director (ED) Brenda Ritter. ED stated she does not administer residents medications. ED stated she is not aware of any instance where a resident was not provided their medication.

On February 17 & 25, 2026, Licensing Program Analyst Manuel Monter interviewed staff S12-S14. S12 stated he/she is aware of a medication issue that occurred with resident R1. S12 stated this error occurred sometime around march 2025. S12 stated R1 had a mediation, M1. S12 stated R1 had an update dosage, from 5mg to 10 mgs, based on what S12 remembers. S12 stated the facility was under administering. S12 stated he/she can’t remember the details.

S13 stated he/she isn’t aware of any issues regarding residents medications. S13 stated R1’s Family member(FM) believed there was in issue with R1’s medication M1. S13 stated R1 had a medication based on a trail period. S13 stated after the trail period had ended, there wasn’t a new prescription to continue using M1. S13 stated he/she had to explain to FM that they can’t administer a medication until they have a doctors order. S13 stated he/she can’t remember the details since it was a year ago.

Page 9 Out of 10.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 12 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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S14 stated there was a few medication errors but cannot remember when this happened or the name of the resident. S14 stated he/she does remember there was some sort of discussion regarding R1’s medication. S14 stated there was an issue getting a doctors order for R1’s medication M1. S14 stated it wasn’t a medication error, the issue was the doctor had not sent the order for M1, and the facility wasn’t able to administer. S14 stated he/she doesn’t’ remember when this issue came up.

On March 4, 2026, Licensing Program Analyst Manuel Monter randomly audited 4 resident centrally stored medication records. The medication audit was completed by cross-referencing the residents’ medications containers with the Centrally Stored Medication log. As a result, LPA did not find any discrepancies.

The Department reviewed R1's Medication Administration record dated July 2025. Under medication M1, there are several blank spaces.

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 10 Out of 10. END OF REPORT.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 13 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On July 29, 2025, the Department interviewed Witness W1. W1 stated on July 16, 2025 when visiting R1, he/she requested to give R1 a shower and asked for R1’s personal care items. W1 stated he/she was given a shower caddy from their med room and discovered that he/she had personal care items in R1’s caddy that were not his/hers. W1 stated the shampoo and soap that belonged to R1 were almost empty. W1 stated he/she could not find the lotion for R1 legs. W1 stated staff could not locate the items he/she supplied and paid for. W1 stated R1 is still missing several items including blankets, tv remote, and a box of ace bandages. W1 stated he/she does not know if the missing items were logged in the personal property log.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed Staff S2-S6. 4 Out of 5 staff (S2-S4, S6) stated they are not aware of any instance of residents losing property. S2 acknowledged there may have been times when residents shampoos may have been mixed with other residents cubbies. S5 stated he/she heard there was an issue regarding R1’s shampoos, but doesn’t know the details.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed Assisted Living Director (ALD) Mayte Calderon. ALD stated she doesn’t know about residents losing things. ALD stated she hasn’t heard or aware of any issues. ALD stated she isn’t aware of bathing products being misplaced.

On January 23, 2026, Licensing Program Analyst Manuel Monter interviewed residents R14-R18. 4 Out of 5 staff (R14-R17) stated they have not had any issues with losing personal property. Resident R18 was unable to provide any relevant information due to neurocognitive disorder.

On February 5, 2026, Licensing Program Analyst Manuel Monter interviewed Community Life Director (CLD) Barbra Fleig. CLD stated if something is lost in the memory care unit, the care staff will look for said missing object. CLD stated the memory care unit is only 1 floor and things are easy to find. CLD stated he/she is not aware of any issues of residents losing personal property.

On February 5 & 9, 2026, LPA Manuel Monter interviewed Memory Care Director Daleht Miranda, referred to as S1 & Staff S7-S11. S1 stated if something is lost with the value of over 100 dollars, then the facility will report it to the police. S1 stated they will also ensure that when residents move in, their personal property they want to be kept safe, is logged on the personal property log. S1 stated she doesn’t know what has occurred regarding R1’s missing things or if they were ever found. Page 4 Out of 6.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 14 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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S7 & S11 stated they are not aware of any issues of residents losing personal property. S8 stated he/she is aware when R1 had allegedly lost his/her foot stool. S8 stated the issue was R1 will pick up and move the foot stool around the memory care unit. S8 stated he/she isn’t aware of the outcome of the issue. S9 stated he/she does faintly remember R1 losing a foot stool. S9 stated he/she remembers looking for it. S9 stated he/she doesn’t remember what happened regarding the foot stool. S10 stated he/she isn’t aware of R1 losing personal property. S10 stated there was instances where residents shampoos and bathing products were swapped or missing.

On February 11, 2026, LPA Manuel Monter interviewed residents R5, R6, R19-R22. 6 Out of 6 residents (R5, R6, R19-R22) stated they haven’t had any issues with their personal property going missing.

On February 11, 2026, LPA Manuel Monter interviewed Executive Director (ED) Brenda Ritter. ED stated she isn’t aware of any instance where a residents personal property had gone missing. ED stated recently there was a resident who “lost” there broom and dust pan and red sheets that were allegedly missing. ED stated she did find the broom and dust pan next to the residents fridge. ED Stated they compensated residents losing property as a credit. ED stated they compensate to give the resident the benefit of the doubt and since these are small charges, it’s a way to keep the residents satisfied with the care is being provided.

On February 17 & 25, 2026, Licensing Program Analyst Manuel Monter interviewed staff S12 – S14. S12 stated he/she is aware that it had been alleged that R1 had missing property. (pair of shoes, foot stool). S12 acknowledged that they did replace those items financially. S12 stated they did a whole memory care unit search but didn’t find said items. S12 stated R1’s Family member wanted the foot stool in the public space, where R1 would usually sit. S12 stated it might have been possible R1’s showering products were placed in the wrong cubby, but he/she isn’t aware of this happening.

S13 stated he/she isn’t aware of any issues regarding residents losing personal property. S13 stated nothing was ever mentioned to him/her about missing property. S14 stated he/she faintly remembers hearing about a missing foot stool and blanket. S14 stated it was ongoing where it would go missing and then be found elsewhere. S14 stated he/she isn’t aware if the blanket or foot stool went missing again or was found again. S14 stated he/she is not aware of any issues regarding residents shampoos / bathing products mixing with other residents shampoos/ bathing products. Page 5 Out of 6.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 15 of 16

Control Number 26-AS-20250707122429

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: WATERMARK AT SAN JOSE, THE	FACILITY NUMBER: 435202937
	VISIT DATE: 03/05/2026

NARRATIVE

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On February 25, 2026, LPA Manuel Monter interviewed Former Administrator Kellie Shearer. ADM stated there were items that may have been misplaced, blankets, sheets, they would replace them. ADM stated if was a person misplaced an item, the facility trying to make amends. ADM stated they will believe the residents if they state they can’t find something. ADM stated staff will try to search for it and compensate to make amends. ADM stated the residents in the memory care unit would take things and move them around the memory care unit. ADM stated R1’s missing items were not in the personal property log and R1’s daughter did not request to add them. ADM stated R1’s FM was compensated for the missing items.

The Department reviewed R1's Personal Property and Valuables Log, LIC621, dated February 16, 2025. Based on a review, this form is blank and signed on the bottom.

The Department reviewed R1's Watermark at San Jose Ledger Report, February 18 - September 2, 2025. The ledger states effective August 28, 2025, R1's was granted $450 in credit for missing items. The ledger states effective September 1, 2025, R1 was granted $418.22 in credit for missing items and erroneous care charges.

The Department reviewed Resident R1's Revenue Concessions Reports, dated August 27, 2025 & September 1, 2025, & September 2, 2025. The report states R1 was compensated for the following missing items: foot stool, TV and Remote, Ace bandages, and Hamper.

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.

Page 6 Out of 6. END OF REPORT

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 16 of 16