Senior Care Records.

Complaint Investigation Report

Belmont Village San Jose, San Jose12/04/2025Licence 435202350

Census106
Date signed12/04/2025 01:44:22 PM
The inspector’s account

LPA interviewed staff S2-S4. S2 stated on September 1, 2025, he/she was preparing breakfast in the kitchen area of the dining room. S2 stated he/she noticed that they needed another meal made because one was missing and he/she asked S1 to contact the kitchen. S2 stated R1 was sitting on a wheel chair close to the telephone, S1 moved R1. S2 stated he/she observed R1 elbow staff S1 and saw R1 roll his/her wheel chair back hitting against S1. S2 stated as he/she saw this, he/she saw S1 then hit R1's right forearm with his/her right hand. S2 stated it was kind of like a reaction. S2 stated he/she asked S1 why he/she did that and S1 apologized.

LPA requested S2 re-enact the hit on LPA's arm. S2's re-enactment was a slap, open handed, swinging the forearm downwards. S2 stated it made a slapping sound. S2 stated it wasn't a full swing.

Staff S3 stated the day of the event, he/she was in his/her office. S3 stated S1 arrived to his/her office. S3 stated staff S1 said, he/she did hit R1. S1 said he/she tried to make a call and R1 hit S1. S1 stated he/she tried to get R1 to stop, and he/she reacted.

Staff S4 stated he/she did work on September 1, 2025, but doesn’t remember where he/she was when the incident occurred. S4 stated he/she didn’t see the incident take place.

On September 1, 2025, local law enforcement (LLE) interviewed resident R1, who did not recall the incident and had no complaint of pain. LLE did not observe any visible injury on R1. LLE interviewed staff S3. S3 stated at approximately 12:30pm, S1 was using the phone in the dinning hall when R1 came up to S1 and hit S1 repeatedly. S1 hit R1 back with an open hand one time causing R1 to stop. S1 reported the incident to S3.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction