435200459-5-9-2025-26-AS-KHOS-DGTMPV-20250519094747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200459
Report Date: 05/09/2025
Date Signed: 05/09/2025 12:17:17 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
12/06/2024 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20241206140503

FACILITY NAME:	HOMELIFE RESIDENTIAL CARE		FACILITY NUMBER:	435200459
ADMINISTRATOR:	JAVIER, JULIUS ERVIN		FACILITY TYPE:	735
ADDRESS:	367 FONTANELLE DRIVE		TELEPHONE:	(408) 578-6257
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	6	CENSUS: 5	DATE:	05/09/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Audrey Salvador		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff financially abused a resident by coercing the resident to purchase items for them.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator (ADM) Audrey Salvador. On 12/06/2024, the department received a complaint with the above allegation. On 12/10/2024, LPA Marrufo conducted an unannounced initial complaint investigation visit.

On 12/05/2024, R1’s Adult Day Program (ADP) facility submitted an Unusual Incident/Injury Report (IR) to the department. The IR stated that on 12/04/2024, R1 was on a community trip to a local mall. During the trip, R1 purchased three jackets totaling $299.99. The ADP staff stated asked R1 if R1 really needed the jackets, but R1 purchased the jackets anyway. ADP staff asked R1 why R1 purchased the jackets and R1 stated that R1’s staff wanted and asked forthe jackets. R1 stated the staff gave R1 their sizes.

See LIC9099-C page for more information. Page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025

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-20241206140503

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: HOMELIFE RESIDENTIAL CARE	FACILITY NUMBER: 435200459
	VISIT DATE: 05/09/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The IR states that on 12/05/2024, R1 told ADP staff that the jackets did not fit the staff, so the staff will take R1 to the mall on the upcoming weekend so they can pick what they want. R1 stated the staff were three males and gave the names of staff, including S2 and S3.

During visit on 12/10/2024, LPA Marrufo interviewed resident R1 and staff S1 and S2 as well as ADM. During interview, resident R1 stated to have purchased jackets for three staff as gifts. R1 stated none of the staff asked R1 to get them a gift. R1 stated to have purchased the gifts, “from the heart.” R1 stated that no one asked R1 to buy him/her a gift. R1 stated to have returned the jackets. R1 stated none of the staff offered R1 anything in return for the jackets. S1 and S2 stated to have never asked R1 for a gift. S1 and S2 stated that R1 offered them jackets as gifts but they did not accept the jackets. ADM stated that none of the staff asked R1 to buy him/her a gift. ADM stated that R1 asked the staff if they wanted a gift and the staff responded, “anything.” During visit on 12/10/2024, ADM counted R1’s money in R1’s Personal and Incidental Money Log while LPA Marrufo was observing and the amount of money was balanced against the log.

During visit on 05/09/2025, LPA Marrufo conducted a telephone interview with S3. S3 stated during interview that R1 asked S3 what kind of gift S3 wanted. S3 stated that although staff are not able to mention what kind of gift they want from residents, S3 told R1, “It is up to you.” S3 stated R1 gave S3 a jacket, but S3 did not accept the jacket because it was too big and expensive. S3 stated during interview to have told R1 to return the jacket. S3 stated to have taken R1 to the mall to return the jacket. S3 stated R1 did not buy anything else for the staff on the day R1 returned the jacket.

During visit on 05/09/2025, LPA Marrufo conducted an interview with S2 and a telephone interview with S1. Both S1 and S2 stated to have not told R1 to buy them another gift when R1 was returning the jackets.

Based on information from interviews conducted with staff, and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Administrator Audrey Salvador and a copy of this report was provided. Page 2 of 2. END REPORT.

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2