435202078-5-15-2024-26-AS-JJIN-D7GS28-20240724132904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202078
Report Date: 05/15/2024
Date Signed: 05/15/2024 05:21:18 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
12/21/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20231221110557

FACILITY NAME:	VILLA 2 RESIDENTIAL CARE HOME		FACILITY NUMBER:	435202078
ADMINISTRATOR:	ARIEL PALENCIA Y		FACILITY TYPE:	735
ADDRESS:	204 N. MORRISON AVE.		TELEPHONE:	(408) 998-2791
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	14	CENSUS: 12	DATE:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:			TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff did not prevent resident from being inappropriately touched by another resident while in care
Staff did not provide a safe and comfortable environment for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Ariel Palencia.

The Department received a complaint with the above allegations on 12/21/2023. The complainant stated that resident R1 has told R2 “I love you,” has touched R2’s food, brushed up against R2’s chest over R2’s clothes, and touched R2’s arm and shoulder without permission.

On 12/21/2023, LPA Marrufo conducted an initial complaint investigation. An additional complaint investigation was conducted on 04/09/2024.

See LIC9099-C for more information. Page 1 of 5.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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 5

Control Number 26-AS-20231221110557

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: VILLA 2 RESIDENTIAL CARE HOME	FACILITY NUMBER: 435202078
	VISIT DATE: 05/15/2024

NARRATIVE

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LPA Marrufo obtained a copy of resident R1’s Appraisal/Needs and Services Plan. R1’s Appraisal/Needs and Services Plan states R1 “experiences frequent sexual preoccupation with peers and staff, and has repeatedly reported that auditory hallucinations influence these decisions.” The document states R1’s socialization needs are to “maintain and respect boundaries of staff and other residents.” The methods of evaluating R1’s socialization progress is stated as “Staff observations, self-report, weekly meeting with case manager.” The document states R1’s mental needs as “minimize psychiatric symptoms” and the method of evaluating R1’s mental needs progress as “Staff observations, self-report, monthly meetings with psychiatrist.”

Administrator (ADM) Ariel Palencia provided LPA Marrufo with forwarded emails between and R1’s psychiatrist. In an email from 12/08/2023, ADM notified R1’s psychiatrist that ADM will get newly prescribed medication for R1. In another email form 05/03/2024, ADM stated ADM stated R1’s labs were taken the day before and was requesting for R1’s psychiatrist to upload the lab results. Microsoft Teams conference invites were sent in emails from 01/25/2023 and 06/06/2023 between ADM and R1’s behavioral management team. In an email from 08/01/2023, R1’s psychiatrist provided ADM with instructions on how to prepare R1 for labs that were scheduled to occur on 08/15/2023.

LPA Marrufo interviewed R1 on 04/09/2024. During interview, R1 stated that ADM told R1 not to touch people. R1 stated that ADM told R1 not to touch people as recently as a couple days prior to the interview. R1 stated to not remember if ADM told R1 not to touch any particular person.

LPA Marrufo conducted a telephone interview with resident R2 on 05/03/2023. R2 stated during interview to prefer not to speak to LPA Marrufo.

During interview on 04/09/2024, ADM stated that R1 and R2 used to live in adjacent bedrooms in the facility. ADM stated that R2 complained to ADM that R1 knocked on R2’s bedroom door in the middle of the night. ADM stated to have interviewed R1 about the incident, and R1 stated to have knocked on R2’s door to ask for cigarettes.

Page 2 of 5.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 26-AS-20231221110557

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: VILLA 2 RESIDENTIAL CARE HOME	FACILITY NUMBER: 435202078
	VISIT DATE: 05/15/2024

NARRATIVE

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ADM stated that R1 would often ask people for hugs. ADM stated that R1 would ask R2 for hugs and sometimes R2 would consent and sometimes R2 would not. ADM stated to have encouraged R2 to say no to hugs.

ADM stated to have not heard anything about R1 touching R2.

ADM stated to have observed R1 touch the food on the plates of other residents. ADM stated to have encouraged R1 to ask for seconds if R1 was still hungry.

ADM stated R2’s care team relocated R2 from the facility shortly after R2 reported the incidents about R1. R2 moved out of the facility on 12/19/2023.

During an interview on 05/04/2023, which was part of another complaint investigation visit at the facility for a complaint that also involved R1, ADM stated that ADM would talk to R1 and R1’s case managers about R1’s touching of other residents. ADM stated to have been in discussions with R1’s case managers about moving R1 to a crisis residential home. ADM stated R1’s case managers would work to have R1’s medications changed. ADM stated R1 used to see R1’s case managers once a week. ADM stated, however, R1’s case management organization has had staffing issues in the past year, resulting in less frequent meetings between R1 and R1’s case manager. ADM stated to not have records of R1’s meetings with R1’s case managers. ADM stated R1 has consistently visited R1’s psychiatrist each month, except for the 3 months prior to the interview. ADM stated R1 visited R1’s psychiatrist once in the past 3 months. ADM stated the staffing issues at R1’s case management organization have impacted R1’s visit schedule to R1’s psychiatrist.

LPA Marrufo conducted a telephone interview with R1’s Conservator (C1) on 05/03/2024. C1 stated to have not have any information on R1 inappropriately touching R2. C1 stated to not know how often R1’s case managers meet with R1 and how often R1 visits R1’s psychiatrist.

Page 3 of 5.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 26-AS-20231221110557

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: VILLA 2 RESIDENTIAL CARE HOME	FACILITY NUMBER: 435202078
	VISIT DATE: 05/15/2024

NARRATIVE

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LPA Marrufo conducted a telephone interview with R1’s Case Manager (CM1) on 05/03/2024. During interview, CM1 stated to have become R1’s case manager three weeks ago. CM1 stated that there have been staffing issues at R1’s case management organization. CM1 stated to have met with R1 once so far. CM1 stated R1 visited R1’s psychiatrist at the end of April. CM1 stated to not have any information about R1 inappropriately touching R2.

LPA Marrufo conducted a telephone interview with R2’s Case Manager (CM2) on 04/09/2024. During interview, CM2 stated that R2 reported to CM2 that R2 reported to CM2 on three different times that R1 would get very close to people and touch their ears and arms.

CM2 was not sure if ADM and facility staff took action to prevent R1 from touching and being inappropriate towards other residents, including R2. CM2 stated that R2 was relocated from the facility one or two days after R2 brought up the complaints about R1 to CM2.

CM2 stated that ADM contacted CM2 minutes after R2 contacted CM2 about R1’s touching and inappropriate behaviors.

LPA Marrufo interviewed residents R3-12 on 05/15/2023. R7 stated to remember resident R2. R7 stated to not have observed anyone touch R2 inappropriately, but did recall seeing residents knocking on R2’s door at night. R7 stated the staff keep the environment safe by issuing notices and 30-day evictions to residents.

Resident R9 stated to not know R2, but observed R1 approach a female resident from the side and touch the female resident’s breasts. R9 stated to not know what staff did to prevent R1 from touching the resident’s breasts.

Resident R11 stated to know of and remember Resident R2. R11 stated that R1 would pretend to give R2 a hug, but then touch R2’s breasts. R11 stated staff told R1 not to touch R2 inappropriately.

Page 4 of 5.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 26-AS-20231221110557

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: VILLA 2 RESIDENTIAL CARE HOME	FACILITY NUMBER: 435202078
	VISIT DATE: 05/15/2024

NARRATIVE

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Residents R1-R6, R8, R10, and R12 stated to not know R2 or have seen R1 touch R2 inappropriately.

LPA Marrufo interviewed staff S1 and S2 on 05/15/2023. Staff S1 stated to have returned from vacation and R2 had left the facility after complaining. S1 stated to not know why R2 complained. S1 stated the staff always tell R1 to not touch anyone inappropriately. Staff S2 stated to not know R2. S2 stated that ADM has told S2 to tell R1 to behave and relax if R1 seems active and energetic. S2 stated to have not seen R1 touch anyone inappropriately.

LPA Marrufo requested a police report from local law enforcement on 04/29/2024, but as of 05/15/2024, LPA Marrufo has not received a response from law enforcement regarding the report.

Based on information from interviews conducted with staff, residents, and third parties, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22.

This report was reviewed with Administrator Ariel Palencia and a copy of this report was provided.

Page 5 of 5.

END REPORT

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

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