West Valley Care Home

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced case management visit to amend a report on 10/9/2025 and re-issue the correct citation and $500 civil penalty for an elopement of Resident R1 that occurred on March 29th, 2025. On April 1, 2025, LPA Tarin interviewed Licensee Zhang. Licensee stated, R1 was found on 3/31/2025 and they do not know where R1 was found. Licensee states he heard from R1's responsible party that R1 was found on Stevens Creek Blvd near a gas station, but does not know the condition of R1. Licensee states R1 was last seen on facility surveillance on 3/29/2025 at 7:21AM. On April 1, 2025, at approximately 4:32pm, local law enforcement was informed R1 was found at Stevens Creek Blvd and Cypress Ave. The Department reviewed R1’s physician’s report dated September 8, 2023, which states R1 is not able to leave the facility unassisted. Based on a Google Maps Review, the location R1 was found was 2.9 miles from the facility, without staff supervision. A Deficiency is being cited under Title 22 Regulation 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities, see LIC809D for more information. As a result, An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility. Licensee stated he was being treated unfairly by the Department and refused to sign the reports. LPA explained to Licensee that his signature of the report acknowledged receipt of the report. Licensee states he would not sign the report and would be appealing the deficiency and civil penalty. A deficiency is being cited during today's visit, see LIC809D. An exit interview was conducted with Licensee. A copy of this report and appeal rights were provided.

Licensing Program Analysts (LPA) Marcella Tarin and Manuel Monter conducted an unannounced annual inspection and to follow up on a resident elopement that occurred in March 2025. LPAs met with Licensee Biao Zhang. LPAs stated the purpose of the visit. LPAs toured the interior and exterior of the facility with Licensee to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. During tour of the interior and exterior of the facility, LPAs observed spiderwebs around residents windows, dirt on residents interior windows,a ripped and torn couch in living room, brown stains on walls through the facility. LPAs also observed two office rooms being used as a resident and staff room. LPAs observed a bed and personal belongs in each 'office' room. LPAs observed medication bottles in 'family room', accessible to residents. During inspection of the backyard facility, LPAs observed a gate that had a lock. Licensee states some residents are not allowed to exit the facility. During visit, Licensee removed the lock from the gate. LPAs observed all other exits and passageways to be free and clear of obstruction. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA measured refrigerator temperature at 35 degrees F and Freezer at 0 degrees F. Page 1 of 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPAs observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by Licensee. Fire extinguishers were last serviced on 2/11/2025. The facility emergency drill log was reviewed. The facility's last drill was on 9/18/2025. LPAs toured 6 resident bedrooms. All 6 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. During inspection of R2's, LPAs observed pills in a cup on R2's dresser. Based on review of R2's physician's report, R2 cannot store or administer his/her own medications. LPAs toured 2 bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPAs measured water temperature with a range of 109 F to 111.5 F. LPAs reviewed 3 resident records. All 3 resident records did not have an updated physician's report, updated service plan, and did not contain personal property log. LPAs reviewed 3 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPAs reviewed 2 staff records. 1 Out of 2 staff records did not have training for 2025. Licensee provided LPAs with a training document for S2 with dated 2025. Upon further review, LPAs observed a handwritten 2025 over the 2024 dates. Licensee stated S2 did not have training for 2025 and apologized for writing 2025 over the 2024 training dates. Elopement incident On April 1, 2025, the Department received an incident Report regarding resident R1. The incident Report stated, on March 29, 2025, resident R1 was missing. R1 was last seen on 3/28/2025, at 11:45pm, by another resident. The incident report states, the facility contacted Campbell police. The incident report states "Based on the surveillance camera record, there was a movement when the sensor light went on at 4:52AM on 3/29/2025" Page 2 of 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 **This is an amended report to issue the correct citation and civil penalty for an elopement** On April 1, 2025, LPA Tarin interviewed Licensee Zhang. Licensee stated, R1 was found on 3/31/2025 and they do not know where R1 was found. Licensee states he heard from R1's responsible party that R1 was found on Stevens Creek Blvd near a gas station, but does not know the condition of R1. Licensee states R1 was last seen on facility surveillance on 3/29/2025 at 7:21AM. On March 29, 2025, Local Law enforcement, at approximately 8:07am, responded to a missing person report, regarding R1. It was reported that R1 was last seen in his/her room at 8:30pm the previous night. When checked approximately 30 minutes later, R1 was no longer there. On March 29, 2025, at approximately 7:30am, it reported that R1 was missing from his/her room. On April 1, 2025, at approximately 4:32pm, local law enforcement was informed R1 was found at Stevens Creek Blvd and Cypress Ave. The Department reviewed R1’s physician’s report dated September 8, 2023, which states R1 is not able to leave the facility unassisted. Based on a Google Maps Review, the location R1 was found was 2.9 miles from the facility, without staff supervision. As a result, an immediate civil penalty of $500.00 is being assessed Section 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities, against the facility today for violation for absence of supervision, which resulted in R1 eloping from the facility. The deficiency and civil penalty are assessed on a case management visit on 12/26/2025. See LIC809 for 12/26/2025. Licensee stated he would not sign the report because it was related to the elopement and civil penalty assessed. Licensee stated he was refusing to sign the report unless LPAs removed the civil penalty. LPA Tarin stated to Licensee the civil penalty would not be removed. Deficiencies are being cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Licensee Biao Zhang and a signed copy of this report was provided.

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection visit at 9:25AM and met with Licensee Biao Zhang. LPA toured the facility inside and out with the Licensee to include the resident dining room, kitchen, resident bedrooms, bathrooms, and exterior. Facility temperature maintained at 71 degrees. Facility staff are fingerprint cleared and associated to facility. All emergency exits were observed to be clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature maintained at 41 degrees F and freezer maintained at -5 degrees F. LPA measured hot water temperature at 106.3 for kitchen and 2 resident bathrooms. LPA observed medications were in a locked top kitchen cabinet. LPA observed additional medication and sharps in two separate unlocked drawers in the kitchen. LPA advised Licensee that all medications and sharps are to be locked and inaccessible to residents in care. LPA Tarin toured resident bedrooms. 6 out of 6 resident bedrooms had functioning lights, storage space for personal belongings, clean bedding, a chair, lamp and dresser/table. In R3's bedroom (resident room 3), LPA observed medication in an unlocked dresser drawer (picture taken). R3 bedroom is a shared bedroom with R2. The facility was equipped with smoke and carbon monoxide detectors and functioned properly when tested. Fire extinguishers were last serviced on 10/06/2023. LPA observed the facility first aid kit and it was observed to be complete. The facility fire/earthquake drill log was reviewed and drills are being conducted quarterly. The last fire drill was conducted on 08/23/2024. Facility has emergency disaster plan. See LIC809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA reviewed 6 residents Centrally Stored Medication and Destruction Records (CSMDR). LPA observed 6 out of 6 CSMDRs are complete with all medications accounted and documented. LPA observed the medication storage area was locked and inaccessible to residents in care. LPA reviewed 6 resident records. LPA observed 5 out of 6 resident records as complete to include a physician's report, TB result, updated appraisal/needs and services plan, identification and emergency contact information, personal rights, and consent forms. Resident (R3) record did not contain an updated physician's report. Resident R3 physician's report was not updated within the year. R3 has neurocognitive disorder. LPA advised Licensee to obtain updated physician's reports for Resident R3. LPA reviewed 3 staff records. LPA observed 2 out of 3 records to include fingerprint clearance, health screening, TB result, and personnel record. Staff 2's file was not available for review. Licensee states he does not have the documents for S2's file. LPA advised licensee that personnel records shall be available for review by the licensing agency. Deficiencies were cited today per California Code of Regulations, Title 22. A Technical Violation was also issued. See LIC809-D. Exit interview was conducted with Licensee Biao Zhang. A copy of this report was provided to Licensee and Appeal Rights were provided.

During interview, Admin stated that the facility did not have any residents that were unable to leave the facility unassisted, however, during review of R1's physician's report, it was indicated that R1 was not permitted to leave the facility unassisted. Admin provided written correspondence with R1's family regarding R1's care at the facility. Text messages indicate that from dates ranging between September 2020 and December 2020, Admin had maintained consistent correspondence with R1's family, and had stated that R1's care needs, particularly as it pertained to wandering, have elevated beyond what the facility can provide, and indicated that both parties had been searching for alternative placement for that entire period, both parties had difficulty finding placement for the resident due to the COVID-19 pandemic. Since the elopement, staff has installed a wireless door alarm to alert staff of potential resident elopements. LPA observed the wireless door alarm to be operation during this visit. In review of photographic evidence submitted by a witness and facility incident report written regarding the elopement, it is confirmed that R1 sustained a bump on their head as well as bruising around the eye during the period in which R1 was not on the premises. The Department has conducted an investigation of the above allegation. Based on records reviewed and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED. Deficiency is being cited and civil penalty is being assessed. See LIC 9099-D and LIC421. This report was reviewed with Administrator Biao Zhang and a copy of the signed report was provided via email due to printer error.