435202078-7-3-2024-26-AS-JJIN-D7222Q-20240709170107

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202078
Report Date: 07/03/2024
Date Signed: 07/03/2024 05:34:35 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
10/27/2022 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20221027105310

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:	07/03/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ariel Palencia		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Resident was sexually abused in care

INVESTIGATION FINDINGS:

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

On 10/27/2022, the Department received a complaint with the following allegation. The initial complaint investigation visit was conducted on 10/28/2022. Additional complaint investigation visits were conducted on 04/26/2024 and 05/03/2024.

On 11/28/2022, the Department received a copy of the Police Report that was reported on 10/25/2022. The Police Report states that resident R1 stated to the responding Police Officer that an unidentified male touched R1’s breasts without R1’s consent. The Police Officer obtained a statement from R1, who went on tangents about dead bodies in the facility backyard and people at the facility who were unrelated to the case. See LIC9099-C for more information. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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 3

Control Number 26-AS-20221027105310

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: 07/03/2024

NARRATIVE

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The Police Officer asked R1 to tell who touched R1’s breasts. R1 stated to not be able to remember. The Police Officer explained to R1 that R1 had previously told mental health workers that resident R2 had touched R1’s breasts and the Police Officer needed R1 to relay that information to the Police Officer.

R1 stated R2 touched R1’s breasts over R1’s shirt approximately 3-5 times on separate occasions, never with R1’s consent. R1 provided a physical description of R2.

The Police Report stated R1 was transported to emergency psychiatric services.

On 05/15/2024, LPA Marrufo conducted a telephone interview with R1’s Case Manager (CM1). During interview, CM1 stated to have conducted a telephone interview with R1 on 05/14/2024. CM1 stated that R1 stated during the telephone interview that R2 would ask R1 for consent for a hug and R1 would hug R2. R1 stated after a while R1 would stop hugging R2. CM1 asked R1 if R2 respected R1’s boundaries to no longer consent to hugs and R1 said yes.

LPA Marrufo interviewed R1 on 05/17/2024 at R1’s current facility. During interview, R1 stated that R2 touched R1’s breast over R1’s shirt. R1 stated to have at times consented receiving hugs from R2. R1 stated to have expressed to no longer wanting to be touched. R1 stated R2 did not respect R1’s boundary. R1 stated to not remember having filed a police report for the incident.

During interview on 05/03/2024, R2 stated to hear voices and experience an impulse and touch someone. R2 stated to not remember R1.
During interview on 05/03/2024, Administrator (ADM) Ariel Palencia stated that R1 would complain to ADM about R2 about R2 hugging R1. ADM stated that if R1 was feeling nice, R1 would allow a hug from R2. ADM stated to not hear any reports about R2 touching R1’s breasts.

During visit on 05/03/2024, LPA Marrufo interviewed 7 additional residents. One of those residents, R3, stated that R2 has touched R2’s breasts and the breasts of other residents at the facility. The six other interviewed residents stated to have not observed any residents touch a resident inappropriately.

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SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 26-AS-20221027105310

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: 07/03/2024

NARRATIVE

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

No Deficiencies were cited under California Code of Regulations Title 22

This report was reviewed with ADM Ariel Palencia and a copy of this report and appeal rights were provided.

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END REPORT

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC9099 (FAS) - (06/04)

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