435200828-4-4-2025-26-AS-KHOS-DFTKV2-20250417081337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200828
Report Date: 04/04/2025
Date Signed: 04/04/2025 04:14:54 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
12/30/2024 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20241230163109

FACILITY NAME:	RICHARDS MANOR II		FACILITY NUMBER:	435200828
ADMINISTRATOR:	RICHARDS, SHIRLEY		FACILITY TYPE:	735
ADDRESS:	4242 MONET CIRCLE		TELEPHONE:	(408) 622-8067
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	6	CENSUS: 3	DATE:	04/04/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Genevieve Mariano		TIME COMPLETED:	10:26 AM

ALLEGATION(S):

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Staff slapped a resident's buttock.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with House Manager (HM Genevieve Mariano.

On 12/30/2024, the Department received a complaint with the allegation that staff slapped a resident's buttock. .

On 1/3/2025, the Department conducted an initial investigation visit. LPA interviewed Administrator (ADM), 4 staff, 1 resident and a family member of a resident.

LPA requested resident's physician report, appraisal Needs and Service plan.

Continue on LIC9099-C. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

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 3

Control Number 26-AS-20241230163109

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: RICHARDS MANOR II	FACILITY NUMBER: 435200828
	VISIT DATE: 04/04/2025

NARRATIVE

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On 1/3/2025, LPA interviewed Administrator (ADM) Shirley Richards. ADM stated resident R1 called police on 12/24/2024 around 5:00PM and claimed that staff S1 touched R1's buttock on 12/23/2024 around 5:00PM. ADM stated police officers came to the facility to investigate and interviewed R1.

ADM stated before R1 called 911 on 12/24/2024, resident R1 blocked resident R2' bedroom door and did not allow R2 to enter to R2's bedroom. ADM stated staff S1 and S2 redirected R1 and separated R1 and R2. ADM stated S1 reported R1's misbehavior to ADM. ADM stated it is believed that R1 was upset with S1 because S1 reported to ADM regarding R1's misbehavior. ADM stated R1 made up a story about being abused by S1. ADM stated he/she did not see S1 touched R1. ADM stated he/she did not receive any report regarding S1 touched R1 from staff or residents.

LPA interviewed staff S1. S1 stated on 12/24/2024, R1 behaved aggressively. S1 stated he/she and staff S2 redirected R1 and separated R1 and resident R2 to protect R2. S1 denied he/she touched R1's buttock..

LPA interviewed staff S2. S2 stated he/she did not see S1 touched R1 neither on 12/23/2024 nor on 12/24/2024. S2 stated he/she was on site with S1 and R1 on 12/23/2024 and 12/24/2024.

LPA interviewed staff S3. S3 stated he/she was not on site on 12/23/2024. S3 stated he/she heard police officers came to investigate on 12/24/2024. S3 stated he/she heard there was no witness for the incident.

LPA interviewed resident R1. R1 stated S1 slapped softly on his/her buttock twice on 12/23/2024. R1 stated he/she does not believe it was a sexual assault. R1 stated he/she does not think it was a physical abuse. R1 stated it was inappropriate behavior. R1 was asked why he/she did not report on 12/23/2024 but reported on 12/24/2024. R1 did not answer.

LPA interviewed R1's family member (FM) on the phone. FM stated the allegation is not true. FM stated he/she asked R1 about the incident, and R1 answered "I don't know". FM stated the facility is a good facility and S1 is a good staff. FM stated he/she does not believe S1 slapped R1's buttock.

Based on the review of R1's appraisal needs and service plan, R1 taking medication to maintain/control his/her mental health issue.
Continue on LIC9099-C. Page 2 of 3.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20241230163109

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: RICHARDS MANOR II	FACILITY NUMBER: 435200828
	VISIT DATE: 04/04/2025

NARRATIVE

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Based on the review of the law enforcement task force report, it states that there is not having sufficient information for the allegation.

Based on investigation, interviews conducted and records reviewed , the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

No citations noted at today’s compliant investigation visit.

Exit interview conducted with HM. The report was provided to HM for review and for signature. A copy of this report was provided to HM.

Page 3 of 3.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3