430707832-1-11-2026-26-AS-RMAO-DQQSMY-20260127130041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430707832
Report Date: 01/06/2026
Date Signed: 01/11/2026 02:41:03 PM

Unsubstantiated

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
09/02/2025 and conducted by Evaluator Maria Partoza

COMPLAINT CONTROL NUMBER: 26-AS-20250902142315

FACILITY NAME:	SUB-ACUTE RESIDENTIAL TREATMENT (SART)		FACILITY NUMBER:	430707832
ADMINISTRATOR:	FERNANDO PAZ		FACILITY TYPE:	772
ADDRESS:	230 N. MORRISON AVE.		TELEPHONE:	(408) 938-8516
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	16	CENSUS: 15	DATE:	01/06/2026
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Christina Rossi - Senior Program Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff is not maintaining accurate records of controlled substances
Facility staff is not adhering to the PRN medications as prescribed
Facility staff is not accurately recording administered medications resulting in frequent medication errors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to deliver the findings of the complaint investigation that was received by the Department on 09/02/25 regarding the above allegations. LPA met with Program Director Christina Rossi and stated the purpose of the visit.

On 09/10/25, the Department conducted an initial investigation, interviewed staff and gathered documents. On 10/06/25 and 12/11/25, LPA conducted additional staff interviews and gathered additional documents.

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see LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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-20250902142315

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: SUB-ACUTE RESIDENTIAL TREATMENT (SART)	FACILITY NUMBER: 430707832
	VISIT DATE: 01/06/2026

NARRATIVE

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Based on interviews staff 1 to 6 (S1–S6), the facility keeps separate binders for controlled substances and the Medication Administration Record (MAR). When controlled medications arrive, two staff record, count, and log them before storing them in a locked cabinet. When dispensing, staff initial the controlled substance binder and note the medication on the MAR. Most controlled medications are PRN. At shift change, two staff recount and initial the log.

Based on record review and interview, staff corrected record entry by crossing out, initialing, and updating both the MAR and narcotics binder.

S1 stated that controlled medications are stored on-site, and clients typically know their medication schedules. Three clients currently have controlled prescriptions. Controlled medications are stored securely at the facility. Clients generally know when and which medication they need to take. All staff can dispense medications upon client request and log the administration in front of the client. All staff are authorized to hand over medication requested by clients.

S2 stated that the program administrator revised procedures so medication administration is logged only on the MAR, while the controlled binder tracks inventory counts. However, S2 admitted logging a dose in the binder but not on the MAR, leading another staff to administer the same medication later that day but not at the same hour.

Based on document review and interview, the facility is using old and new forms, resulting in errors in recording medications correctly. Staff previously signed only the controlled substance binder, creating an error. A new policy was placed that requires staff signing the MAR at shift end to prevent early dosing. To prevent recording errors.

S3 stated that staff generally follow doctor’s orders, with rare minor errors such as missed documentation or incorrect RX numbers. Medication records should include count, reason for administration, and staff signature. Controlled substances are logged with client name, initial count, and time administered. Clients request PRNs before administration, and errors are corrected promptly. S3 did not witness any wrong medication being given.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250902142315

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: SUB-ACUTE RESIDENTIAL TREATMENT (SART)	FACILITY NUMBER: 430707832
	VISIT DATE: 01/06/2026

NARRATIVE

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S4 stated catching daily errors in medication entries, including missing doctor’s orders, undocumented doses, incorrect pill counts, and mismatched records across multiple clients. One incident involved a controlled substance given an hour early, creating overdose risk. S4 stated these errors to the program administrator and is concerned about risks of overdose and regulatory violations.

S5 stated he/she observed MAR discrepancies that risked double dosing. S5 identified and reported two errors, sent an email to prevent overdose, and S5 stopped a client from receiving an extra dose. To mitigate risk, S5 double-checks records before administering medication and emphasized that staff adherence to protocols and accountability must be addressed by licensee or management.

S6 stated there was confusion due to simultaneous use of old and new forms, causing inconsistencies in medication tracking. At least one staff member does not follow procedure. Controlled medications are rare, but staff must strictly follow as needed medications (PRN) protocols, with clients requesting doses before administration. Staff should initial the MAR and log inventory in the controlled binder; errors are corrected by crossing out and re-entering information. MAR guides timing for next doses, and medication errors trigger full investigations. Staff previously did not discontinue medication, but issues were caught before harm occurred. S6 supervises staff closely and reports concerns to licensee.

S1 to S6 stated, the facility maintains separate binders for controlled substances and the Medication Administration Record (MAR). Controlled medications are logged, counted, and stored securely. Staff stated procedural system contributes to documentation errors. Staff stated confusion due to old and new forms being used concurrently, leading to inconsistencies. Staff stated errors included missed MAR entries, incorrect counts, and early dosing, however S1 to S6 stated most were corrected before harm occurred.

Although the allegation 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 allegation is unsubstantiated.

No deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with Program Director Christina Rossi and a copy of the report was provided.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

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