435200791-5-29-2024-26-AS-RMAO-D5WQ7X-20240604115553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200791
Report Date: 04/28/2024
Date Signed: 05/29/2024 10:34:44 AM

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
03/29/2022 and conducted by Evaluator Maria Partoza

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220329113337

FACILITY NAME:	CONSTANTIN'S CARE HOME		FACILITY NUMBER:	435200791
ADMINISTRATOR:	LAPUSTEA, CONSTANTIN		FACILITY TYPE:	740
ADDRESS:	5836 ETTERSBERG DRIVE		TELEPHONE:	(408) 229-0365
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	6	CENSUS: 6	DATE:	04/28/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Constantin Lapustea		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff beats up resident

INVESTIGATION FINDINGS:

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The report was amended based on additional information received by the department.

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannouced visit to the facility to deliver the findings on the above allegation. LPA met with LIcensee/Administrator (ADM) Constantin Lapustea and stated the purpose of the visit.

On 3/29/2022, the department received the complaint and conducted an initial investigation on 4/7/2022. LPA Dolores, requested documents and interviewed staff on 4/7/2022. On 4/5/2024, LPA Partoza continued with the investigations, requested and reviewed additional documentations, interviwed staff and residents.

page 1 continued to page 2 - LIC 9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20220329113337

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: CONSTANTIN'S CARE HOME	FACILITY NUMBER: 435200791
	VISIT DATE: 04/28/2024

NARRATIVE

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This report is being amended based on additional information received by the department.

Based on interviews of residents (R2 to R4), they are not aware of any staff hurting or beating on residents. Based on R2s account of events of 3/28/2022, resident 1 (R1) has aggressive behavior. and he/she would leave the room for safety. R3 stated that staff are not hurting residents in care. R4 recently moved in to the facility and have not experienced, heard or witness a staff hurting a resident.

Based on interview and documented statement of staff (S1 to S3). S1 wrote and stated that R1 was the aggressor and physically assaulted S1. S1 stated on the day of the incident, S1 was assisting R1 to prepare for R1s appointment, as soon as the sweater came off, R1 pushed S1 hard and started to scream and accused S1 of hitting him/her. S2 on a written statement stated, that he/she heard the yelling and ran to the room to assess the situation and witnessed R1 hitting S1 and asked R1 to take medication to calm R1 down, but R1 knocked the pills off S2s hand and refused to take the medication. S3 in a written statement stated that law enforcement was called on the day of the incident 3/28/2022 and interviewed staff.

Based on law enforcement (LE) report review, Law enforcement interviewed R1 and S3, R1 could not provide details of the incident due to neurocognitive disorder. S3 stated that he/she held R1 to prevent R1 from hitting S1. Based on the police report R1 did not have visible marks or bruising and R1 stated he/she did not have any marks or bruising.

This agency investigated the complaint alleging that a staff beat the resident. We have found that the complaint was unfounded, meaning that the allegations was false, could not have happened and/or is without reasonable basis.

No deficiency was cited during today's visit. An exit interview was conducted with LIC/ADM Constantin Lapustea. A copy of the signed report was provided.

end of report
page 2

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC9099 (FAS) - (06/04)

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