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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435200234
Report Date: 06/04/2025
Date Signed: 06/04/2025 04:32:44 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
02/28/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250228090241
FACILITY NAME:SUNRISE HOMEFACILITY NUMBER:
435200234
ADMINISTRATOR:MENDOZA, AURORAFACILITY TYPE:
735
ADDRESS:2046 LAVONNE AVENUETELEPHONE:
(408) 272-0587
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:6CENSUS: 6DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Staff Lourdes CeraTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility staff neglected resident's hygiene needs as resident had not showered and changed clothes for 3 days
Facility did not report an infectious disease outbreak
INVESTIGATION FINDINGS:
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On 6/4/2025 Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced visit to deliver the findings of the complaint investigation. LPA met with Staff Lourdes Cera and stated the purpose of the visit. LPA spoke with Administrator (ADM) Christia Mendoza Vasquez via phone, who was unable to be present during visit. ADM authorized Staff Lourdes Cera to sign on her behalf.

On 2/28/2025, the Department received a complaint with the above allegations.

On 3/5/2025 the Department conducted an initial investigation and conducted interviews and requested copies of documents. On 4/4/2025, the Department continued with the complaint investigation and conducted additional interviews.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
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-20250228090241
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: SUNRISE HOME
FACILITY NUMBER: 435200234
VISIT DATE: 06/04/2025
NARRATIVE
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On 3/5/2025 and 4/4/2025 LPA conducted an interview with the following individuals, witness 1 (W1), 3 staff (S1, S2, and S3) 1 resident (R1). LPA interviewed W1 who stated that R1 was wearing the same clothing for days and have not showered. W1 stated that R1 responds with a yes or no answer when spoken to in English. W1 stated that R1 prefers to speak in his/her native language and responds to an individual who speaks the same language as him/her. W1 stated if redirected, R1 will comply. W1 stated that R1 sometimes have some aggression and R1s behavior is at Level 3.

Based on interviews 3 Out of 3 staff stated that there are times that R1 refuses to bathe for three days in a week. 3 Out of 3 staff stated that staff will ask R1 multiple times and R1 will agree if redirected or when rewarded. 3 Out of 3 staff stated when redirection does not work the staff will call R1s RP to help out. 3 Out of 3 staff stated that R1 can understand English but only responds with a yes or no. 3 Out of 3 staff stated that R1 responds to an individual who speaks his/her native language. LPA attempted to interview R1, R2 and R3 but is not able to communicate clearly. 3 Out of 3 staff states that R1 can be aggressive when frustrated. 3 Out of 3 staff stated no other residents have problem taking a shower.

1 Out of 3 staff stated that R1s behavior therapist visits at least 3 times a week it started 3 weeks ago (mid March). 1 Out of 3 staff stated that staff are trained by the behaviorist on how to redirect R1, however redirection sometimes does not work and staff will call R1s RP. 1 Out of 3 stated that when therapist are at the facility R1 will take his/her shower.

3 Out of 3 staff stated the residents got sick but was not Covid. 3 Out of 3 staff stated there was no infectious disease outbreak. 3 resident was sick with different diagnosis and different times. 2 residents did not get sick and no staff got sick. R1 was given Ibuprofen, R2 was given antibiotic and R3 was given cough medication.

Based on interview and observation, although the allegation may have happened or is valid, there is not a preponderance of evidence to proved that the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

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

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SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
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