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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201046
Report Date: 04/30/2024
Date Signed: 04/30/2024 04:39:51 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/10/2023 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20230310144123
FACILITY NAME:LASSENPARK RESIDENTIAL HALL(RH)FACILITY NUMBER:
435201046
ADMINISTRATOR:VALIN, AMOR & VIRGILFACILITY TYPE:
735
ADDRESS:364 LASSENPARK CIRCLETELEPHONE:
(408) 227-1129
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:6CENSUS: 5DATE:
04/30/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Virgil ValinTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff are not allowing residents to leave the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced complaint investigation visit to deliver the investigation finding and met with Administrator (ADM) Virgil Valin.

On 3/10/2023, the Department received a complaint with the allegation that facility staff are not alloing residents to leave the facility.

On 3/17/2023, an initial investigation visit was conducted. LPA interviewed ADM, 1 staff and 5 residents.

LPA requested residents' Physician’s Report’s, Appraisal/Needs and Service Plan and schedule of staff.


Continue on LIC9099-C. Pgae 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
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-20230310144123
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: LASSENPARK RESIDENTIAL HALL(RH)
FACILITY NUMBER: 435201046
VISIT DATE: 04/30/2024
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Staff are not allowing residents to leave the facility:
On 3/17/2023, LPA interviewed Administrator (ADM). ADM stated the facility conducts all the efforts to protect all the residents and staff for health and safety. ADM stated the facility set up protocols/rules to protect residents and staff for COVID pandemic. The protocol/rules were discussed with families and case managers, and were in agreement with them. ADM stated one of the rules is to conduct COVID test after residents returning to the facility from outside. ADM stated residents are allowed to leave the facility to go to doctor appointments, to go out with case manager, or with family. ADM stated all residents are in compliance with the protocol except one resident R1 who refused to take COVID test after returning to the facility from outside. ADM stated R1 went out to roam in the streets or parks, but not for doctor appointments, not with case manager, or not with family.

LPA interviewed staff S1. S1 stated the facility has protocol/rules for COVID, and residents need to follow the rules to protect all the residents and staff. LPA observed a case manager took a resident out from the facility during LPA's visit.

LPA interviewed 5 residents. 4 out of 5 residents stated they agreed to follow the facility rule for the COVID. 1 out of 5 resident stated that he/she is independent and COVID was almost gone in March 2023, and he/she wanted to go outside without restriction.

Based on interviews, the facility allowed residents to go out for doctor appointments, with case managers, and with family. The facility required residents to take COVID test after returning to the facility. Resident R1 refused to take COVID test after returning to the facility.

In March 2023, COVID was not "totally" gone, facilities still took some measures to protect residents in care.

The department has investigated the above allegation. Based on the interviews, the Department found that the allegations 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 allegation did or did not occur.

No citation was noted today. The report was provided to ADM for signature.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2