435202154-9-26-2025-26-AS-RMAO-DMEKME-20251013080125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202154
Report Date: 08/05/2025
Date Signed: 09/26/2025 04:38:24 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
05/28/2025 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20250528112445

FACILITY NAME:	MISSION BAY, INC.		FACILITY NUMBER:	435202154
ADMINISTRATOR:	MARIA COKER		FACILITY TYPE:	775
ADDRESS:	980 RINCON CIR.		TELEPHONE:	(408) 433-3303
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95131
CAPACITY:	135	CENSUS: 114	DATE:	08/05/2025
		UNANNOUNCED	TIME BEGAN:	10:55 PM
MET WITH:	Raul Regencia		TIME COMPLETED:	11:39 PM

ALLEGATION(S):

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Client sustained unexplained bruise due to physical abuse.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Program Director (PD) Raul Regencia.

On 05/28/2025, the Department received a complaint with the allegation that client sustained unexplained bruise due to physical abuse.

On 5/30/2025, the Department conducted an initial investigation visit.

LPA interviewed PD, 5 staff, and client C1.

LPA request physician report, appraisal needs and service plan, and Individual Program Plan (IPP).

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: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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-20250528112445

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: MISSION BAY, INC.	FACILITY NUMBER: 435202154
	VISIT DATE: 08/05/2025

NARRATIVE

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On 5/30/2025, LPA interviewed Program Director (PD) Raul Regencia. PD stated on 5/23/2025, he/she received a phone call from client C1's care home staff and notified him/her that C1 sustained bruise on left arm. PD stated he/she received photos of R1's bruise from C1's care home staff. PD stated after reviewed the photos, it looks like the bruise already 2-3 days. PD stated staff S1 denied he/she grabbed C1 or hurt C1. PD stated he/she did not receive report that C1 had incident on 5/23/2025. PD stated he/she interviewed another 4 staff, all of them stated C1 did not have any incident on 5/23/2025. PD stated he/she interviewed a client who was in the same van with C1 on 5/23/2025, and another client who was in the same group with C1 on 5/23/2025, both of them stated C1 did not have any incident on 5/23/2025. PD stated he/she interviewed C1 and C1 stated he/she sustained the bruise from C1's care home. PD stated a client C2 who has the same first name as S1, was in different group and in different van with C1 on 5/23/2025. PD stated C1 and C2 did not have any contact on 5/23/2025.

LPA interviewed client C1. LPA observed C1 had purple bruise on the left arm. C1 did not say the bruise is painful. C1 provided the name of the people who hurt him/her. LPA checked the day program staff roster and there was no staff with the name provided by C1.

LPA interviewed staff S1. S1 denied he/she grabbed C1 or hurt C1 on 5/23/2025.

LPA interviewed staff S2. S2 stated he/she looked at the photos sent by C1's care home staff on 5/23/2025, regarding C1's bruise and it looks like the bruise already 3 days because the bruise looks yellowish. S2 stated C1 did not have incident on 5/23/2025.

LPA interviewed staff S3. S3 stated C1 showed his/her bruise on the left arm at the reception area when C1 arrived at the day program facility on 5/23/2025. S3 stated C1 told him/her that C1 sustained the bruise from C1's care home.

LPA interviewed the driver and care staff of the van to pick up C1 and drop off C1 on 5/23/2025. Both of them stated C1 did not have incident during the pick up and drop off.

Based on the review of the incident report dated 5/27/2025, C1's family member reported a complaint to police department. C1's family member withdrew the charge of the complaint later.
Continue on LIC9099-C. page 2 of 3.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250528112445

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: MISSION BAY, INC.	FACILITY NUMBER: 435202154
	VISIT DATE: 08/05/2025

NARRATIVE

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Based on the review of C1's appraisal needs and service plan dated 11/19/2024, C1 has a history of challenging behaviors including running away, jumping from moving vehicles, and is monitored for physical aggression such as hitting with a closed fist, licking, and pushing which could cause pain or injury. C1 also exhibits behaviors like smearing fences, climbing fences and making stories.

On 09/16/2025, LPA conducted an unannounced collateral visit at C1's care home and interviewed Care home Administrator (ADM) Ganiyu Ajani and two C1's care home staff (CS1, CS2). ADM, CS1 and CS2 stated on 8/23/2025, C1 was observed without any bruise on the body before went to day program. ADM and CS1 stated C1 on 8/23/2025, C1 had red mark on the arm when C1 returned to the care home. ADM and CS1 stated C1's red mark was observed fresh but not old red mark. ADM stated the name that C1 told the day program was a resident 10 years ago. LPA interviewed 6 residents in the care home. 2 out 6 residents are non verbal. 4 out of 6 stated the care home no one hurt them in the facility and they likes to live in the facility.

Based on the investigation, interview, records reviewed, the Department found that the above allegation is 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 allegation did or did not occur.
Citations were noted today.

No citations noted at today’s compliant investigation visit. Exit interview conducted with PD. This report was provided to review and for signature. A copy of this report was provided to PD.

Page 3 of 3.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3