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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435200432
Report Date: 10/10/2025
Date Signed: 10/10/2025 04:34:16 PM

Substantiated


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
10/06/2025 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20251006091443

FACILITY NAME:CARRANZA #1FACILITY NUMBER:
435200432
ADMINISTRATOR:CARRANZA, EDUARDOFACILITY TYPE:
735
ADDRESS:2052 LADDIE WAYTELEPHONE:
(408) 809-4715
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY:6CENSUS: DATE:
10/10/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Eduardo CarranzaTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Licensee allowed an uncleared adult to reside in the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to open the initial complaint investigation. LPA met with Administrator Eduardo Carranza

On October 6, 2025, the Department received a complaint alleding the Licensee allowed an uncleared adult to reside in the facility.

On October 10, 2025, LPA Monter interviewed staff S1. S1 confirmed his/her family member (FM) has been staying and residing in the staff room for the past month.

LPA interviewed ADM. ADM stated he is unaware how long FM has been staying in the facility. FM stated FM hasn't been finger printed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20251006091443
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: CARRANZA #1
FACILITY NUMBER: 435200432
VISIT DATE: 10/10/2025
NARRATIVE
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LPA interviewed FM. FM confirmed he/she has been living at the facility for the past month. FM provided his/her drivers license.

LPA searched FM on Guardian Background Check System. FM is not listed in the guardian database.

ADM asked FM to leave the facility as he/she is not finger print cleared

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC9099-D. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for FM residing in the facility without receiving a criminal record background clearance.

Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20251006091443
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: CARRANZA #1
FACILITY NUMBER: 435200432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2025
Section Cited
CCR
80019(e)
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80019 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility:
This requirement was not met as evidenced by:
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ADM asked FM to leave the faciltiy. ADM stated FM is going to get his/her finger prints done. ADM stated FM will send a plan of action on how those who work/reside at the facility are finger print cleared before working or residing in the faciltiy.
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Based on interview, observation and record review FM was residing in the facility without obtaining a criminal record background clearance which poses an immediate health, safety and personal rights risk to persons in care.
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ADM stated he will submit the written plan of action to the Department by POC due date, October 11, 2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4