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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201046
Report Date: 12/23/2024
Date Signed: 12/23/2024 04:32:46 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
11/13/2024 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20241113140752

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: 4DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Erlinda AsuncionTIME COMPLETED:
04:32 PM
ALLEGATION(S):
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Staff are not equipped to meet the needs of residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver investigation findings and met with staff Erlinda Asuncion (EA).

On 11/13/2024, the Department received a complaint with the allegation that staff are not equipped to meet the needs of residents in care..

On 11/20/2024, the Department conducted an initial investigation visit.

LPA interviewed ADM, staff S1, and 4 residents (R1 - R4). LPA requested LIC 500, resident's physician report, pre assessment and appraisal needs and service,

LPA toured the facility including resident rooms, restrooms, garage, backyard and front yard.
Continue on LIC9099-C. Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20241113140752
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: LASSENPARK RESIDENTIAL HALL(RH)
FACILITY NUMBER: 435201046
VISIT DATE: 12/23/2024
NARRATIVE
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Staff are not equipped to meet the needs of residents in care:
The allegation is that facility staff are not equipped to assist resident R1 for safety for the movability limitation.

On 11/20/2024, LPA interviewed ADM. ADM stated R1 can walk with walker independably. ADM stated R1 wants to be independent and does not likes help if not necessary.

ADM stated he/she can conduct care and supervision to residents without any problems. ADM stated S1 and S2 are capable to do their duty and work. ADM stated R1's needs are met at the facility.

LPA interviewed staff S1. S1 stated he/she and S2 can fulfill their duty and work.

LPA interviewed R1. R1 stated he/she can enter and exit the facility through the main entrance without help. R1 stated he/she likes the facility and without any complaint against the facility. R1 stated the staff treat him/her good and are capable to do their duty and work.

LPa interviewed the other 3 residents. One resident does not know English. One resident was sleeping and did not like to have interview. The last resident stated he/she likes the facility and without any complaint.

LPA observed R1 walking from R1's room to living room and from living room to R1's room without any help. LPA asked R1 if he/she needed help and R1 replied No. LPA observed R1 exited the facility through the main entrance and got on SUV.

Base on the interview and observation, there is no evidence to indicate staff are not equipped to meet the needs of R1.

Based on documents reviewed, and interviews conducted, the Department found that the above allegations are 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 citations noted for today’s visit. Exit interview was conducted with EA. A copy of this report was provided to EA. Page 2 of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5