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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430708736
Report Date: 09/28/2024
Date Signed: 09/28/2024 02:54:49 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
07/05/2023 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20230705151829
FACILITY NAME:VILLA VERDEFACILITY NUMBER:
430708736
ADMINISTRATOR:JULIETA EXTRAFACILITY TYPE:
740
ADDRESS:4751 CALLE DE TOSCATELEPHONE:
(408) 978-7937
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:6CENSUS: 4DATE:
09/28/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee, Dominica OliviaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff is verbally humiliated and verbally abused the resident.
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 the Licensee, Dominica Olivia and stated the purpose of today’s visit.

On 7/5/2023, the Department received a complaint with the above allegations. On 7/13/2023, the Department conducted an initial investigation at the facility.


Continuation on LIC 9099-C, Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2024
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 2
Control Number 26-AS-20230705151829
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: VILLA VERDE
FACILITY NUMBER: 430708736
VISIT DATE: 09/28/2024
NARRATIVE
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Page 2 of 2.

On 7/13/2023, the Department interviewed 3 staff (S1-S3). Three out of the three staff stated they did not observe or hear a staff member verbally humiliate or verbally abuse a resident. S1 stated there is a staff member that speaks loudly but cannot recall when staff have humiliating or verbally abusing the residents.

On 7/13/2023, the Department interviewed 2 residents (R1-R2). One resident declined to answer LPA’s questions regarding the allegation. R2 stated staff have not been rude or loud to the residents and cannot recall an incident where staff have humiliating or verbally abusing the residents.

On 7/12/2024, the Department interviewed 1 witness (W1). W1 stated staff would assist residents but cannot recall a time where staff were humiliating or verbally abusing residents. W1 has not seen or heard any staff verbally humiliating or verbally abused the resident.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee, Dominica Olivia and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2