Senior Care Records.

Complaint Investigation Report

Evergreen Guest Home #4, San Jose04/12/2024Licence 435202168

Census5
Date signed04/12/2024 03:31:15 PM
The inspector’s account

LPA Maruffo interviewed ADM. ADM stated the facility showers the residents at least once a day. ADM stated the facility will also shower and change the residents if they have an accident as well. ADM stated R1 has a behavior of putting his/her hand in his/her mouth. ADM stated the staff will re-direct the R1, but its an ongoing behavior. ADM stated the staff will clean up R1, after he/she puts his/her hands in his/her mouth, but the smell of saliva is going to be there.

LPA Maruffo made the following observations on July 15, 2022. LPA observed 6 out of 6 residents clothes as hygienic. LPA did not observe residents in disheveled or soiled state.

On December 12, 2023 and April 12, 2024, LPA Monter observed 4 residents at the facility, including R1. LPA did not observe residents in disheveled or soiled state.

Based on a review of R1's Individual Program Plan, dated, February 22, 2022, R1 has a behavior of frequently putting his/her hands in his/her mouth.

There is no sufficient evidence to prove or disprove the allegation that abuse, or assault occurred. The preponderance of the evidence gathered and analyzed indicated that the allegation is not true, therefore, the allegation is UNSUBSTANTIATED .

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