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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202154
Report Date: 12/30/2025
Date Signed: 12/30/2025 01:13:40 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
11/20/2025 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20251120082233
FACILITY NAME:MISSION BAY, INC.FACILITY NUMBER:
435202154
ADMINISTRATOR:MARIA COKERFACILITY TYPE:
775
ADDRESS:980 RINCON CIR.TELEPHONE:
(408) 433-3303
CITY:SAN JOSESTATE: CAZIP CODE:
95131
CAPACITY:135CENSUS: 1120DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Raul RegenciaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff is financially abusing resident.
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 11/20/2025, the Department conducted an initial investigation visit.

LPA interviewed PD and 3 staff.

On 12/04/2025, LPA conducted an unannounced investigation visit and interviewed PD and 6 staff. Client C1's physician report, Appraisal/needs and service plan and Individual development plan were obtained.

Continue on LIC9099-C. Page 1 of 4.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
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 4
Control Number 26-AS-20251120082233
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: 12/30/2025
NARRATIVE
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On 11/20/2025, staff S1 was interviewed by LPA. S1 stated on 10/15/2025, client C1 and C1's family member (FM) arrived at the facility parking lot around 1:45PM to 2:00PM for C1 to join the facility bowling activity. S1 stated Supervisor (SV) was with him/her and FM told him/her that C1 had money with C1 for the bowling activity. S1 stated he/she did not hear any amount of money was with C1. S1 stated he/she told FM that he/she will tell staff S2. S1 stated C1 was not in his/her group on 10/15/2025 afternoon. S1 stated he/she did not touch C1's money on 10/15/2025 and did not see any staff touched C1's money. S1 stated the fee for C1's bowling activity is $10.00.

LPA interviewed staff S2. S2 stated he/she took C1 for bowling activity on 10/15/2025. S2 stated C1 gave him/her the wallet and he/she just took $10.00 from C1's wallet. S2 stated he/she returned the wallet to C1. S2 stated he did not count how much money was in C1's wallet. S2 stated he/she gave the $10.00 to supervisor.

LPA interviewed staff S3. S3 stated he/she is a driver. S3 stated on 10/15/2025, he/she drove C1 for the bowling activity, but he/she did not touch C1's money.

On 11/25/2025, LPA interviewed FM. FM stated on 10/15/2025, he/she gave C1 $50.00 and the fee for the bowling activity is $10.00. FM stated C1 should have $40 left in the wallet. FM stated on 10/17/2025, he/she gave C1 $20.00 for the Fun Friday activity. FM stated he/she only found a receipt of $17.00 in C1's wallet.

On 12/04/2025, LPA interviewed staff S4. S4 stated he/she never touched any client's money. S4 stated on 10/15/2025, FM dropped C1 at the facility and attempted to give him/her $10.00 for C1's bowling activity. S4 stated he/she told FM to give the $10.00 to S2 or S3. S4 stated later he/she observed S2 took $10.00 because S2 announced it in loud and showed to everyone that S2 only took a $10.00 bill from C1's wallet.

LPA interviewed S2. S2 stated on 10/15/2025, C1 gave him/her C1's wallet to pay the $10.00 fee for bowling activity. S2 stated he/she only took $10.00 from the wallet and showed it to everyone. S2 stated S4 is the witness that he/she only took $10.00 from C1's wallet. S2 stated he/she saw there was some money in C1's wallet but he/she did not count it.

Continue on LIC9099-C. Page 2 of 4.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20251120082233
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: 12/30/2025
NARRATIVE
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LPA interviewed Supervisor (SV). SV stated on 10/15/2025, he/she was with FM and S1 all the time when FM was at the facility. SV stated he/she did not hear FM talking about any amount of money. SV stated FM sometimes was forgetful. SV stated FM usually prepares lunch boxes for C1. SV stated one time he/she saw C1's lunch box was empty and called FM; FM stated he/she forgot to put the lunch in C1's lunch box. SV stated S2 gave him/her $10.00 for C1's bowling fee and he/she gave S2 the receipt.

LPA interviewed Program Director (PD). PD stated on 10/15/2025, FM attempted to give $10.00 to staff S4 but S4 asked FM to give S2 or S3. PD stated FM claimed he/she put $50.00 in C1's wallet for C1's bowling fee and stated he/she told staff S1 that C1 had $50.00 in the wallet. PD stated S1 denied he/she heard C1 had $50.00 in the wallet. PD stated the facility supervisor stated he/she was all the time with FM on 10/15/2025 during FM's stay at the facility and did not hear FM talking about the amount of money in C1's wallet. PD stated C1 spent $10.00 on 10/15/2025 and the facility gave the receipt to C1. PD stated on 10/17/2025, FM gave $20.00 to C1. PD stated on 10/17/2025, C1 spent $11.80 on lunch and $7.54 for snack in the afternoon. PD stated the facility gave both receipts to C1.

PD stated on 10/21/2025, FM notified him/her that he/she only found a receipt of $17.00 in C1's wallet. PD stated he/she requested to see the receipt of $17.00 and FM agreed to bring to the facility. PD on 11/07/2025, C1's Service Coordinator (SC) set up a meeting with PD, FM and the facility staff. PD stated he/she asked FM for the receipt of $17.00 but FM stated he/she cannot find it. PD stated SC interviewed all staff involved but there was no confirmed conclusion for the allegation. PD stated the meeting came out new procedures for the outings/activities on Wednesdays and Fridays to prevent the incidents/arguments happening again.

PD stated there are possibilities between 10/15/2025 and 10/21/2025 that C1 and FM had some activities, but FM forgot. PD stated FM cannot provide a copy of the receipt of the $17.00. PD provided a copy of the receipt of $11.80 spent on 10/17/2025 at Jack in the Box.

Based on the review of C1's physician report, C1 is unable to manage the cash money. Based on the review of C1's IPP, C1 needs support for purchases with cash money.

Continue on LIC9099-C. Page 3 of 4.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20251120082233
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: 12/30/2025
NARRATIVE
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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.

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 4 of 4.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4