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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201311
Report Date: 08/25/2023
Date Signed: 08/25/2023 02:38:25 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
06/15/2023 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20230615095332
FACILITY NAME:ROSSMORE A.R.F. HOMEFACILITY NUMBER:
435201311
ADMINISTRATOR:HELEN V. CARRANZAFACILITY TYPE:
735
ADDRESS:2955 ROSSMORE LANETELEPHONE:
(408) 531-9487
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY:6CENSUS: 4DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Ernie ManaoisTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Resident sexually abused in facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator (ADM) Ernie Manaois.

On 06/15/2023 the department received a complaint alleging that resident (R1) was sexually abused in the facility.

On 06/20/2023 resident R1 was interviewed by the department. R1 was asked in anyone hurt him/her in the facility, R1 stated no one at the facility hurt him/her but the residents were not nice to him/her. R1 stated his/her sibling has done things to him/her. When asked if anyone else has hurt R1, R1 stated his/her parent. R1 stated he/she sustained injuries before being admitted to the hospital (current location). R1 had no visible injuries. The department also interviewed medical social worker (MSW1). MSW1 stated there was no visible injuries when R1 came to the hospital.
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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-20230615095332
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: ROSSMORE A.R.F. HOME
FACILITY NUMBER: 435201311
VISIT DATE: 08/25/2023
NARRATIVE
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On 8/25/2023 LPA Manuel Monter interviewed 4 out of 4 residents (R2-R5). 4 out of 4 residents interviewed stated they have not been touched inappropriately in the facility. 4 out of 4 residents interviewed stated they have not heard other residents complaining or mentioning inappropriate touching.

A review of R1's needs and services plan, dated 10/29/2022, shows that R1 suffers from mental illness and delusions. A review of R1's physicians report, dated 10/14/2022, states R1 suffers from mental illness and delusions.

LPA interviewed S1. S1 stated he/she has worked at the facility for almost one year and eight months. S1 stated he/she has not heard residents complaining about inappropriate touching. S1 stated he/she has never seen the other staff or residents inappropriately touching. S1 stated R1 was mentally ill and defiant. S1 stated R1 would tell outlandish lies such as his/her room being filed with snakes.

LPA interviewed ADM. ADM stated he/she has been working at the facility for 8 years. ADM stated he/she has not heard residents ever complaint about inappropriate touching. ADM stated he/she has not heard from staff about inappropriate touching. ADM stated that has never happened at the facility. ADM stated R1 suffers from mental illness and would make up stories.

Based on the interviews conducted with clients and staff and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited, Exit interview conducted with Administrator Ernie Manaois
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
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