435202973-9-15-2026-26-AS-RMAO-DYSN27-20261012100413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202973
Report Date: 09/15/2026
Date Signed: 09/15/2026 04:09:31 PM

Unfounded

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
05/04/2026 and conducted by Evaluator Simranjit Rai

COMPLAINT CONTROL NUMBER: 26-AS-20260504112510

FACILITY NAME:	NOVELLE SENIOR LIVING		FACILITY NUMBER:	435202973
ADMINISTRATOR:	WELCH, JOYCE		FACILITY TYPE:	740
ADDRESS:	3355 ALMADEN EXPRESSWAY		TELEPHONE:	(408) 869-5403
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	250	CENSUS: 94	DATE:	09/15/2026
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Administrator Joyce Welch and Guest Services Director Naoko Howard		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not provide timely medical attention to resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Administrator Joyce Welch and Guest Services Director Naoko Howard and stated the purpose of today’s visit.

On 05/04/2026, the Department received a complaint with the above allegation. On 05/05/2026, the Department conducted an initial investigation at the facility.

It was alleged that on 04/18/2026 resident (R1) was found unresponsive by facility staff and facility staff did not call 911.

Continuation on LIC 9099-C, Page 1 of 2.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20260504112510

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: NOVELLE SENIOR LIVING	FACILITY NUMBER: 435202973
	VISIT DATE: 09/15/2026

NARRATIVE

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Page 2 of 2.
On 05/04/2026, the Department interviewed Witness (W1). W1 stated on 04/18/2026 at approximately 9:57am, facility staff entered R1’s room after W1 noted that R1 was not responsive to phone calls. W1 stated facility staff observed R1 unresponsive and left the room immediately. At approximately 10:01am, W1 entered R1’s room and observed R1 unresponsive on the bed and called 911. W1 stated Emergency Medical Technician responded to the 911 call and arrived to R1’s room at 10:15am. W1 stated he/she heard there were two 911 calls made regarding R1, so the facility staff did make the phone call for R1 to receive medical attention.

On 05/05/2026, LPA Rai spoke with Resident Care Director (RCD) Blyth Obien and Guest Service Director Naoko Howard. Both staff stated the facility staff called 911 after staff observed R1 unresponsive in the room. RCD stated facility staff, 1 family member and 1 resident was present in the room when R1 was found unresponsive.

Based on records of first responders who reported to the scene on 04/18/2026 at 10:05am, they observed bystander, staff and family on scene with R1. Per R1’s family, R1 was found unresponsive in bed and he/she alerted the staff who then came to R1’s room and called 911. Report stated staff moved R1 to the floor and performing CPR with 911 instructions. Report stated the first responders took over the resuscitative efforts. After consultation with physician, resuscitation was terminated at 10:20am.

Based on LIC 624A, facility staff report on 04/18/2026 at 09:25am, R1 was found unresponsive in room on the bed by care staff, R1’s family and another resident. Per report, 911 was called and staff was instructed to start CPR. Based on R1’s Death Certificate, R1 passed away on 04/18/2026 at 10:20am and the cause of death was cardiovascular arrest with a time interval between onset and death as immediate. Per Certificate, R1’s death was noted as immediate and nothing indicated R1’s death as suspicious.

The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.
No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator Joyce Welch and Guest Services Director Naoko Howard and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026

LIC9099 (FAS) - (06/04)

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