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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202937
Report Date: 04/17/2026
Date Signed: 05/05/2026 12:29:18 PM

Substantiated


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
09/08/2025 and conducted by Evaluator Maria Partoza
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20250908150102
FACILITY NAME:WATERMARK AT SAN JOSE, THEFACILITY NUMBER:
435202937
ADMINISTRATOR:KELLIE SHEARERFACILITY TYPE:
740
ADDRESS:1017 S BASCOM AVETELEPHONE:
(520) 797-4000
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:205CENSUS: 110DATE:
04/17/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jolie HigginsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
A3. Facility staff did not respond to call buttons in a timely manner
A4. Facility staff did not ensure the kitchen is kept sanitary ***amended and transferred to LIC 9099A due to additional information received***
INVESTIGATION FINDINGS:
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13
***On 5/5/2026. LPA Maria (Mita) Partoza, AMENDED the report due to additional information received for allegation A4***
Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to deliver the findings of the complaint received by the Department and met with current Executive Director/Administrator (ED/ADM) Jolie Higgins. LPA stated the purpose of the visit. On 09/08/2025, the Department received a complaint with the above allegations out of 6. The Department conducted initial investigations on 09/12/2025, 11/05/2025, and 02/24/2026.
Allegation 3: Facility staff did not respond to call buttons in a timely manner. Based on interviews, on 09/12/25, witness 1 (W1) reported that resident 2 (R2) described delayed responses to pendant calls, approximately 3 weeks prior to 09/09/25, when resident 1 (R1) required assistance due to vomiting. On 11/05/25, LPA conducted an interview with R2 who stated that responses to call buttons often took one hour or more. page 1
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
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 6
Control Number 26-AS-20250908150102
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: 04/17/2026
NARRATIVE
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On 01/14/26, LPA interviewed staff S1, S3, S4 who stated that the typically response times of are approximately 15 to 20 minutes but stated delays may occur when staff are assisting other residents or during periods of high workload.

Based on record review of pendant call logs for R1 from 08/01/25 through 12/31/25 there were 316 documented activations. Of those, 61 calls had response times ranging from 21.2 minutes to 67.8 minutes, with the longest recorded response time of 67.8 minutes on 08/07/25. Although delayed responses were not directly observed during the investigation, the facility’s records document multiple instances of extended response times.

Allegation 4: Facility staff did not ensure the kitchen is kept sanitary - ***AMENDED - DUE TO ADDITIONAL INFORMATION received see LIC 9099A.***

Based on observations and interviews, during the initial inspection conducted on 09/12/25, LPA observed conditions in the kitchen that were not maintained in a clean and safe manner. LPA observed ice accumulation on the freezer floor creating a slippery surface, indications that maintenance of the freezer unit was needed. Photographs were taken at the time of observation. LPA observed used rags on the food preparation area and an open trash bin. LPA checked and observed that the refrigerator temperature was at 50 degrees Fahrenheit, which exceeds the required range for safe food storage. The freezer temperature was measured at 0 degrees Fahrenheit, which is within regulatory range. LPA interviewed 2 kitchen staff (KS), 1 out of 2 staff stated that there was a call out and had to pull a double shift. 1 out of 2 staff stated, 2 people work in the kitchen. **2 kitchen staff (KS1 and KS2)**

On 01/14/26, LPA interviewed staff S1, S2, S3, S4 stated that caregivers are not permitted in the kitchen and did not report direct observations regarding kitchen sanitation conditions.

page 2
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
09/08/2025 and conducted by Evaluator Maria Partoza
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20250908150102

FACILITY NAME:WATERMARK AT SAN JOSE, THEFACILITY NUMBER:
435202937
ADMINISTRATOR:KELLIE SHEARERFACILITY TYPE:
740
ADDRESS:1017 S BASCOM AVETELEPHONE:
(520) 797-4000
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:205CENSUS: 110DATE:
04/17/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jolie HigginsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
A1. Facility staff did not administer correct medication to resident
A2. Facility staff left resident in a soiled diaper overnight
A5. Facility staff did not deliver food in a timely manner in the resident's room
A4. A4. Facility staff did not ensure the kitchen is kept sanitary*** amended from LIC 9099***
A6. Facility does not have the number of staff to care for the residents
INVESTIGATION FINDINGS:
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This page is the continuation of the findings based on the allegations as stated on the LIC 9099
Continued from LIC 9099.
Allegation 1: Facility staff did not administer correct medication to resident

Based on interviews and record review, on 09/12/25, W1 stated that R2 stated R1 missed medication for eight days; however, no specific dates were provided. On 11/05/25, R2 stated they did not recall specific missed doses due to recent relocation. On 01/14/26, R2 reported ongoing medication concerns since 04/22/25, including that the pharmacy dispensed quantities below prescribed amounts (e.g., 150 pills instead of 180 pills). On 01/14/26, Staff 4 (S4) reported one instance where medication delivery from the pharmacy was delayed until approximately 9:00 a.m. the following day and described the facility’s process for monitoring medication supply.
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 26-AS-20250908150102
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: 04/17/2026
NARRATIVE
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Allegation 2: Facility staff left resident in a soiled diaper overnight
Based on interviews, on 09/12/25, witness 1 (W1) reported that resident 2 (R2) stated, that resident 1 (R1) was left in a soiled brief for several hours, approximately 3 months prior. On 11/05/25, R2 reported one incident involving a soiled brief for R1, and this occurred approximately three months ago. On 01/14/26, staff 1 (S1) and staff 4 (S4) stated they had not observed R1 left in a soiled brief overnight. S4 reported that R1 was changed multiple times during night shifts.
Staff 3 (S3) stated residents are checked every two hours and, when possible, it was more frequently for R1, but stated that residents may delay activating their call pendant or decline assistance.
***Allegation 4: Facility staff did not ensure the kitchen is kept sanitary - transferred from LIC 9099C due to new information received*** On 11/05/25, Former ED/ADM stated that the maggots were seen in the garbage outside of the facility not inside the kitchen. This happened when there were delays when the garbage was not picked-up on time by the garbage truck. On 01/14/26 LPA interviewed resident 2 (R2) who stated that he/she was told by 2 staff (caregivers) that maggots were seen on the kitchen floor while they were taking the garbage out, R2 does not remember the names of the staff and did not see the maggots personally. On 5/5/26 LPA interviewed 2 kitchen staff (KS3 & KS4). KS3 & KS4 stated no other staff are allowed in the kitchen, except kitchen staff who cleans and take away the garbage. KS3 & KS4 did not observe maggots on the floor since they started working at the facility for over a year.***
Allegation 5: Facility staff did not deliver food in a timely manner
Based on interviews, on 09/12/25, W1 reported hearing concerns from R2 regarding meal delivery; however, no specific details or dates were provided. On 11/05/25, R2 reported one instance in which a meal delivery took more than one hour but could not recall the date. On 01/14/26, S3 recalled one similar incident but did not provide a specific date. S2 reported that typical food preparation and delivery time is approximately 15 to 20 minutes, with a 5 minute longer wait times for special orders, and stated that no complaints had been received.
Allegation 6: Facility does not have sufficient staff
Based on interviews and record reviews, 09/12/2025, W1 reported that the facility appeared disorganized but did not provide specific information regarding staffing levels. On 11/05/25, R2 reported high staff turnover. On 01/14/26, S1 and S4 stated staffing levels were sufficient. S3 stated that while response times may be delayed during high workload periods, required checks are conducted every two hours, with occasional delays of approximately 30 minutes. Based on record review of the facility's LIC 500 (Personnel Summary Report) the facility has adequate staffing and is in process of hiring more people.

Based on interview, document reviews and observation; although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. No deficiencies were cited for the above allegations per CCR Title 22. An exit interview was conducted with ED/ADM Jolie Higgins and a copy of the report was provided.
page 5 end of report
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 26-AS-20250908150102
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: 04/17/2026
NARRATIVE
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During the follow-up inspection on 11/05/2025, 02/24/26 and today's visit 04/16/2026, LPA observed the refrigerator and freezer within appropriate temperature ranges, floors free of debris, no safety hazards, trash stored in a designated outdoor area not conducive to pest activity, and kitchen access are limited to kitchen staff. Adequate staffing was observed. The conditions observed on 09/12/25 were not observed during the follow-up inspection on 11/05/2025, 02/24/2026 and during today's 04/17/2026.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation 3 and 4 are found to be SUBSTANTIATED. ***Amended - Allegation 4 (A4) due to additional information received, A4 is unsubstantiated, see LIC 9099A.***

California Code of Regulations (CCR) Title 22, Division 6, Chapter 8, Section 87468.2 Personal Rights and 87555(b)(27) – Food Service, are being cited on the attached LIC 9099D. ***Amended LIC 9099D for 87555(b)(27) is removed due to unsubstantiated findings based on the additional information received.***

An exit interview was conducted with Executive Director/Administrator Jolie Higgins and copy of the report and appeals rights were provided.

See LIC 9099 A for the continuation of the report.

page 3
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 26-AS-20250908150102
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2026
Section Cited
CCR
87468.2(a)(4)
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87468.2 Personal Rights (a) ...residents … shall have all of the following personal rights: … (4) To care, supervision, and services that meet their individual needs and are delivered by staff .... This requirement is not met as evidenced by:
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ED/ADM stated that he/she will submit a written plan of correction to address the call light by administering in-service training with Assisted Living Staff and the will submit proof of correction by 4/22/2026
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Based on record review, staff did not, respond timely to request for assistance. R1’s call log documented 316 activations (08/01/25–12/31/25), including 61 calls with response times up to 67.8 minutes, which poses a immediate health safety & personal rights risk to persons in care.
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Type A
04/18/2026
Section Cited
CCR
87555(b)(27)
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87555(b)(27) – General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter... This requirement is not met as evidenced by: *removed due to addt'l info***
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ED/ADM stated he/she will submit a written plan of correction to address the kitchen maintenance and will submit the plan of correction by the POC dute date of 04/18/2026. *** CITATION REMOVED DUE TO ADDITONAL INFORMATION RECEIVED***
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Based on observation, the facility did not maintain the kitchen in accordance with regulatory requirement. On 09/12/25, LPA observed ice accumulation, food debris, refrigerator temperature of 50°F. which poses an immediate health, safety & personal rights risk to residents in care.
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***citation removed due to additional information received.***
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6