435200727-7-28-2026-26-AS-RMAO-DXJ9BK-20260901231339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200727
Report Date: 07/07/2026
Date Signed: 07/28/2026 06:19:56 PM

Unfounded

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
05/13/2026 and conducted by Evaluator Maria Partoza

COMPLAINT CONTROL NUMBER: 26-AS-20260513081241

FACILITY NAME:	CARLTON PLAZA OF SAN JOSE		FACILITY NUMBER:	435200727
ADMINISTRATOR:	SHANTELA YADAO		FACILITY TYPE:	740
ADDRESS:	380 BRANHAM LANE		TELEPHONE:	(408) 972-1400
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	183	CENSUS: 136	DATE:	07/07/2026
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Shantela Yadao		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff does not ensure resident can make and receive confidential calls
Staff does not ensure resident has a signal to call for help
Staff retains resident who wants to relocate
Staff does not allow resident to choose their own doctor

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to deliver the findings of the complaint received by the Department. LPA met with Executive Director/Administrator (ED/ADM) Shantela Yadao.

On 05/13/2026, the Department received a complaint with the above allegations. On 05/15/26, LPA conducted interviews with resident and staff and inspected resident rooms and interviewed FM2. LPA gathered documents pertaining to the above allegations.

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

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 4

Control Number 26-AS-20260513081241

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: CARLTON PLAZA OF SAN JOSE	FACILITY NUMBER: 435200727
	VISIT DATE: 07/07/2026

NARRATIVE

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Facility staff do not ensure resident can make and receive confidential calls.
The reporting party (RP) stated Resident 1 (R1) could not receive telephone calls from family members and was upset because staff did not allow R1 to receive calls.

On 05/15/2026, LPA interviewed R1 who stated he/she uses a personal cellular phone to send text messages and communicates by text messages because of difficulty hearing voice calls. LPA interviewed resident 2 (R2), who stated R2 uses a personal cellular phone to make and receive calls and stated no one listens to R2’s telephone conversations. LPA interviewed staff 1 and 2 (S1 and S2), who stated residents use personal cellular phones to make and receive calls and staff do not participate in residents’ personal communications.

Based on interviews and observations, LPA observed R1 using a personal cellular phone and receiving text messages. LPA observed R1’s room did not have a landline telephone.

Facility staff do not ensure resident has a signal to call for help.
The reporting party (RP) stated staff removed R1’s signal device and R1 could no longer signal for help.

On 05/15/2026, LPA inspected six (6) resident rooms and observed the facility was equipped with emergency pull cord systems mounted on the wall of the bathroom, living area, and next to the bed, residents had call pendants, voice-activated communication devices in the assisted living section, and a monitoring system designed to detect falls in the memory care section.

While conducting the interview with R1, LPA asked permission from R1 to test his/her call pendant and R1 consented. LPA observed staff responded to the call within five minutes. R1 stated he/she uses the call pendant and emergency pull cord when assistance is needed. LPA interviewed R2, who stated R2 has access to a call pendant, emergency pull cords, and a voice-activated communication device. LPA asked permission from R2 to test the call pendant and R2 consented. LPA observed staff responded within five minutes. S1, S2, and staff 3 (S3) stated residents have access to emergency call pendants, pull cords, and voice-activated communication devices to contact staff. S1, S2, and S3 demonstrated how residents use the voice-activated communication device to contact the front desk.
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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20260513081241

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: CARLTON PLAZA OF SAN JOSE	FACILITY NUMBER: 435200727
	VISIT DATE: 07/07/2026

NARRATIVE

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Based on observations, LPA observed resident apartments were equipped with emergency pull cords strategically placed in the resident’s room, residents had emergency pendants, and voice-activated communication devices. LPA observed memory care resident apartments were equipped with a fall detection system.

Facility staff retain resident who want to relocate.
The reporting party (RP) stated R1 wanted to relocate from the facility and staff did not listen to R1 when R1 expressed a desire to leave.

On 05/15/2026, LPA interviewed R1, who stated he/she wanted to move out of the facility and live with family member 1 (FM1). R1 stated he/she discussed moving out of the facility with family member 2 (FM2) and expressed that he/she had decided to move in with FM1. R1 stated FM2 did not agree.

LPA interviewed S1, S2, and S3, who stated residents may relocate from the facility at any time; however, residents are requested to provide 30-day written notice. S2 and S3 stated R1's responsible party was FM2, FM2 would notify the facility by providing the required 30-day written notice. S1, S2, and S3 stated staff do not prevent residents from relocating from the facility. S3 stated that FM2 was aware of R1’s desire to relocate and live with FM1.

On 05/18/2026, LPA interviewed FM2, who stated he/she and FM1 disagreed regarding R1's relocation from the facility. On 05/19/2026, LPA received email correspondence from FM2, who stated family members discussed R1's request to relocate from the facility. FM2 stated they were not going to prevent R1 from leaving the facility with FM1. FM2 further stated R1 left the facility with FM1.

On 05/21/2026, LPA received and reviewed email correspondence from S3, which included an email from FM2 dated 05/17/2026 notifying the facility that FM1 would be taking R1 to an appointment and that the email should serve as R1's 30-day written notice if R1 did not return to the facility. S3 stated R1 left the facility with FM1 and did not return to the facility.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20260513081241

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: CARLTON PLAZA OF SAN JOSE	FACILITY NUMBER: 435200727
	VISIT DATE: 07/07/2026

NARRATIVE

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LPA reviewed R1's admission agreement, which states: The resident may terminate the agreement at any time, with or without cause, by providing the Executive Director or designee with 30 days' written notice.

Facility staff do not allow resident to choose their own doctor.

The reporting party (RP) stated facility staff required R1 to use a physician associated with the facility.

On 05/15/2026, LPA interviewed R1, who stated he/she has a personal physician and no staff at the facility told R1 to see a different physician associated with the facility. LPA interviewed R2, who stated he/she can choose a physician and had not been told which physician to see. LPA interviewed S1 and S2, who stated residents may use physicians of their choice and may request to change physicians if they choose.

Based on interviews conducted, observations made, testing performed, and records reviewed, LPA observed R1 had access to confidential communications and emergency call systems, reviewed records documenting R1 relocated from the facility following notice provided to the facility, and obtained information from interviews that residents may choose their own physicians.

This agency has investigated the complaint with the following allegations that facility staff do not ensure resident can make and receive confidential calls; facility staff do not ensure resident has a signal to call for help; facility staff retain resident who wants to relocate; and facility staff do not allow resident to choose their own doctor. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened, and/or are without a reasonable basis.

No deficiencies were cited based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted and copy of the report was provided to ED/ADM Shantela Yadao

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end of report

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

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