435201311-5-30-2025-26-AS-RMAO-DHG28P-20250608171036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201311
Report Date: 05/30/2025
Date Signed: 05/30/2025 01:15:49 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
07/23/2024 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20240723151818

FACILITY NAME:	ROSSMORE A.R.F. HOME		FACILITY NUMBER:	435201311
ADMINISTRATOR:	HELEN V. CARRANZA		FACILITY TYPE:	735
ADDRESS:	2955 ROSSMORE LANE		TELEPHONE:	(408) 531-9487
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY:	6	CENSUS: 5	DATE:	05/30/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrative Assistant Ernie Manaois		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff do not provide adequate food service to residents

INVESTIGATION FINDINGS:

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On May 21, 2025 the Department received a complaint alleging Staff do not provide adequate food service to residents. It has been alledged the facility meals consists of Cups of Noodles, sandwiches, and salads are never served.

On August 2, 2024, LPA Manuel Monter interviewed residents R1-R3. All resident interviewed stated they do not have dietary food restrictions. R1 stated the facility makes pancakes, waffles, oatmeal. R1 stated he/she doesn’t like when they make sandwiches for lunch.

R2 stated the facility makes spaghetti, sandwiches and soup. R3 stated the facility makes the following food; hamburgers, chicken sandwiches, French fries, spaghetti, pork, salad. R3 stated most of the time, the staff offers vegetables and fruit.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

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-20240723151818

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: 05/30/2025

NARRATIVE

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LPA interviewed staff S2. S2 stated the residents don’t have a restricted diet. S2 stated the facility meals are based on the facility menu. S2 stated he/she follows the facility menu.

Based on a review of the facility weekly menu, the facility offers a variety of meals throughout the month. These meals detail the what is being offered for breakfast, lunch and dinner. The weekly menu contains the following, but not limited to food: vegetable omelet, season fruit, grilled ham/cheese sandwich, fruit salad, lasagna, beef, burritos, turkey sandwich, Sunnyside up eggs, rice, broccoli, mash potatoes, etc.

On May 30, 2025, LPA interviewed residents R1-R4. All residents interviewed stated the facility provides meals that include meat, vegetables and fruits. All residents interviewed stated they meals provided are meeting their needs and have no issues regarding the meals.

LPA interviewed Staff S2 and S3. Both staff interviewed stated the facility makes meals based on what is on the menu. S2 and S3 stated the meals will include a protein such as chicken, beef, or eggs. S2 and S3 stated the meals will also have fruits and a side salad, which will have vegetables as well.

LPA interviewed Administrative Assistant (AA) Ernie Manaois. AA stated the facility provides food based on what is on the menu. AA stated they will typically provide the main course, with fruits and a salad for residents meals. AA stated the food the residents might get include: American breakfast, cereal, eggs, juice, sandwiches, salads, vegetables, broccoli, zucchini, Colla flower, lettuce, rice etc. AA stated the facility makes meals that meet the nutrition needs of the residents.

Based on investigation, records 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 allegations did or did not occur.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

LIC9099 (FAS) - (06/04)

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