Senior Care Records.

Facility Evaluation Report

Villa Glen Home Two, San Jose09/21/2023Licence 435202768

Capacity6
Census6
Date signed09/21/2023 12:21:31 PM
The inspector’s account

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit. LPA met with administrator (ADM) Maria Marquez.

On 09/21/2023, Desk Duty officer, LPA Manuel Monter received an incident report form the facility, Villa Glen Home 2. The incident report stated resident R1 was fixated on hurting resident R2 on 9/18/2023. R1 attempted to hit R2 at 10:30pm. Staff intervened and redirected. R1 made another attempt at 12:15am, but was re-directed again. Then before 2am, R1 had entered R2's room and began hitting R2. Staff intervened and 911 was contacted.

On 09/21/2023, at 10:40 am. LPA Monter arrived at the facility and asked ADM questions regarding the incident. ADM stated that she does not know exactly what caused this to occur. ADM stated R1 has not had a change in medication. ADM stated both of the residents have been living at the facility for 3 years. LPA observed R1's bedroom and R2's bedroom are not connected by a wall and are directly across from each other in the hallway. ADM stated there is an awake night shift staff. 3 live in staff at the time.

LPA requested the following documents for R1 & R2;

needs and services, IPP, Physicians Report, progress notes for that week in question. The facility's plan of action to keep the residents safe.

Needs further investigation. No deficiencies cited as this time.

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