Incident investigation·May 27, 2025

On May 27, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident inspection visit regarding a self-reported SOC 341 for the financial abuse incident. Upon arrival, the LPA was greeted by the Executive Director (ED), Tyler Manzo. The LPA disclosed the purpose of the visit. ED stated that on May 21, 2025, at approximately 11:00 AM, the daughter of resident R1 contacted the facility to report that R1 had been writing checks to their caregiver, staff member S1, at Belmont Village Sunnyvale. The family member (FM) provided copies of six (6) cashed checks dating back to August 26, 2024, totaling $6,850. R1 was his own financial power of attorney and resided in the Assisted Living unit of the community. S1 did not and would not have access to R1. The ED reported reviewing evidence showing that six checks were endorsed on the back and cashed by the facility employee, S1. As a result, S1 was terminated over the phone. The ED noted that there had been no prior concerns or complaints involving S1. The ED confirmed that the facility has a policy prohibiting employees from accepting gifts from residents or their family members. In cases where residents or families insist on giving a gift, the policy requires the employee to report it to the ED, who then contacts the power of attorney (POA) to determine proper handling. The ED further stated that on May 23, 2025, S1 returned to the facility and returned $5,000 in cash from the total $6,850 received from R1. S1 reportedly lacked the funds to return the remaining $1,850. The ED met with R1 and the FM at 2:30 PM to hand over the $5,000 returned by S1. The ED confirmed that S1 remained terminated from employment and that the partial repayment did not affect the termination decision. LPA conducted a wellness check on R1 by visiting their room. R1 stated that they were doing good and it was their judgement to write checks to S1, and no one forced R1 to write checks. Continued on LIC809-C R1 mentioned that they recently gave one check to S1 in the amount of $5000. Prior to that R1 had given checks in the amount of about $2000 as S1 was not paid when S1 was sick or taking care of their family. R1 stated that S1 never demanded any money and it was R1's impression that S1 needed help. R1 further stated that they still worry about S1 as it was their fault and hope the licensing department is not too tough on S1. LPA requested and received the following documents from the ED: 1) R1's admission agreement 2) R1's care plan 3) R1's LIC 602 Physician’s Report 4) Copies of the 6 checks (front and back) 5) Facility's Work Rules 6) Notes on the facility’s investigation and corrective action 7) S1's employee file 8) Staff schedule for the months when the checks were given No deficiencies were cited during today's visit. An exit interview was conducted with the Executive Director. A copy of this report was provided to the Executive Director, Tyler Manzo, whose signature on this form confirms receipt of the report.