Complaint Investigation Report, 11/14/2024 — Evergreen Guest Home #2, San Jose CA

LPA Monter interviewed residents R2-R6. R3 stated staff do take them to their doctors’ appointments. R5 stated he/she doesn’t know if staff take him/her to his/her doctors’ appointments. R6 stated his/her family member takes him/her to the doctors’ appointments. 2 Out of 5 residents (R2, R4) interviewed were unable to provide answers to LPA's questions. Residents interviewed had behaviors such as not talking, ignoring questions, being distracted and engaging in other actions such as playing with toy/tablet.

On September 28, 2024, LPA Monter interviewed ADM. ADM stated R1 has not missed his/her doctors’ appointment. ADM stated the facility has a written log for appointments R1 had attended.

On October 22, 2024, LPA Monter interviewed R1. R1 stated he/she missed 2-3 appointments with his/her doctor. R1 stated the staff wouldn’t take him/her because his/her appointments were in Los Gatos, and it was too far. R1 stated he/she does not know the dates of when he/she had missed his/her doctors’ appointments. R1 stated his/her Family member or Service coordinator would know what appointments he/she missed.

LPA interviewed R1’s Family member (FM). FM stated he/she is aware of the allegations but doesn’t know how many or when they were missed. FM stated R1’s services coordinator is the best person to contact as he/she has the information.

On October 30, 2024, LPA Monter interviewed R1’s Service Coordinator (SC). SC stated he/she does not know what medical appointments have been missed. SC stated he/she does not have R1's medical appointment records.

Based on a review of the facility’s record of medical dental, the facility took R1 to his/her appointments for the following dates. August 7,14,24 & 30, 2023. September 1, 2023. December 20 & 28, 2023. January 11, 26 and 31, 2024.

The Department has reviewed the complaint allegation. Based on information from interviews conducted, and records reviewed, although the allegation listed above 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 . Page 2 Out of 4.