435201454-2-12-2024-26-AS-KHOS-D36MD8-20240308083043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435201454
Report Date: 02/12/2024
Date Signed: 02/12/2024 05:07:42 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
01/31/2022 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20220131125644

FACILITY NAME:	CARRANZA 2 A.R.F.		FACILITY NUMBER:	435201454
ADMINISTRATOR:	HELEN CARRANZA		FACILITY TYPE:	735
ADDRESS:	4339 MOORPARK AVE.		TELEPHONE:	(408) 873-7390
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	12	CENSUS: 7	DATE:	02/12/2024
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Ernie Manaois		TIME COMPLETED:	03:08 PM

ALLEGATION(S):

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There is a urine smell in resident room.
Staff is not doing laundry as needed for the resident.
Staff uses a bat to threaten residents.
Staff yells at the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the complaint investigation findings and met with Administrator (ADM) Ernie Manaois.

On 1/31/2022, the Department received a complaint with the above allegations.

On 2/10/2022, an initial investigation visit was conducted, ADM and a staff (S1) were interviewed. Resident physician report and Apprasial Needs and Service Plan were obtained.

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: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 26-AS-20220131125644

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: CARRANZA 2 A.R.F.	FACILITY NUMBER: 435201454
	VISIT DATE: 02/12/2024

NARRATIVE

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There is a urine smell in resident room:
On 2/10/2022, LPA toured the facility with ADM. R1's bedroom window was opened when LPA toured R1's bedroom. R1's bedroom did not have smell of urine. When LPA toured other resident bedrooms, the windows of the bedrooms were observed closed, and there were no smell of urine in the bedrooms. ADM stated resident R1 was incontinent, but the facility tried the best to make the room clean.

Based on the observations, there was no smell of urine in resident rooms during LPA's touring and checking the resident bedrooms.

Staff is not doing laundry as needed for the resident:
On 2/10/2022 around 9:50AM, LPA toured the facility with ADM. During the tour of R1's bedroom, LPA found R1's soiled clothing was in the laundry basket in R1's bedroom. ADM stated the facility just changed R1's clothing as needed due to R1's incontinent, and the facility did the laundry 3 times per day for R1. ADM stated the facility is going to do laundry for R1. ADM stated the facility conducted the laundry once per week for each resident, and did the laundry 3 times per day for R1 as needed. During the tour of the other resident bedrooms, LPA did not find any soiled clothing in the other resident bedrooms and the soiled clothing found in the laundry basket in R1's bedroom was just changed in the morning before LPA's inspection. During LPA's visit, ADM conducted a laundry for R1's soiled clothing.

Based on the observations and interviews, the facility conducted the laundry one time per week for residents and conducted laundry 3 times per day for R1.

Staff uses a bat to threaten residents:
Staff yells at the residents:

On 2/10/2022, LPA interviewed ADM. ADM stated he/she did not threaten residents, nor saw or heard any staff threatened residents. ADM stated he/she did not yell at residents, nor saw or heard any staff yelled at residents.

Continue on LIC9099-C, page 2 of 3.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 26-AS-20220131125644

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: CARRANZA 2 A.R.F.	FACILITY NUMBER: 435201454
	VISIT DATE: 02/12/2024

NARRATIVE

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LPA interviewed staff S1. S1 denied he/she used a bat to threaten residents. S1 stated he/she did not yell at residents. S1 stated he/she sometimes might raise the voice when talked to residents, but never yelled at residents. S1 stated several residents need to be taken care, and the residents had some mental disorders, so sometimes he/she raised the voice to instruct residents or to get residents' attention. S1 stated he/she works for the facility since January 2019, and never yelled or threatened residents.

LPA interviewed 5 residents. 5 Out of 5 residents stated there were no staff threatened them or yelled at them, nor saw or heard facility staff staff threatened residents or yelled at residents.

Based on interviews with staff and residents, there was no evidence to show that the facility staff threatened or yelled at residents.

Based on investigation, observations, 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.

No deficiencies or citations noted at today’s compliant investigation visit.

Exit interview conducted with ADM. A copy of this report was provided to ADM.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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