435202171-8-11-2025-26-AS-RMAO-DLAUB8-20250907152556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202171
Report Date: 08/11/2025
Date Signed: 08/11/2025 10:17:52 AM

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
06/02/2025 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20250602131131

FACILITY NAME:	TERRA COTTA HOME		FACILITY NUMBER:	435202171
ADMINISTRATOR:	ANGELINA DOOLABH		FACILITY TYPE:	735
ADDRESS:	3233 TERRA COTTA DR.		TELEPHONE:	(408) 270-7440
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	6	CENSUS: 5	DATE:	08/11/2025
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Manharlal Doolabh		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff are hitting a client while in care

INVESTIGATION FINDINGS:

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On 8/11/2025, LPA Grace Donato arrived unannounced to deliver a complaint investigation findings. LPA met with Co-Administrator Manharlal Doolabh. LPA explained the purpose of the visit.

Regarding the allegation of Staff are hitting a client while in care, Reporting Party (RP) stated that he/she has seen older women (who appear to be caregivers) hitting and slapping the disabled adult. In one incident, an adult patient was visibly crying and being slapped by an older Asian woman.

LPA interviewed staff members. S1, who have worked in the facility for 8 years, mentioned that they have a resident (R1) who goes out in the backyard before and yells. That is R1s behavior, they let R1 shout and then R1 just goes back inside. It has been a while since he/she did this. R1 is always inside shouting in his/her room then just stops.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250602131131

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: TERRA COTTA HOME	FACILITY NUMBER: 435202171
	VISIT DATE: 08/11/2025

NARRATIVE

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There is another resident (R2) who also shouts but is always inside the facility. There are no instances where resident were slapped or hit by the staff. The residents are treated like they are our kids, they are well taken care of. S2, who have been in the facility for almost 10 years, also stated that it has been a year since R1 has went outside to shout. R1 just stays in his/her room and shouts there then covers himself/herself with a blanket. No staff has ever hit any resident. The Co-Administrator (COA) also mentioned that they haven’t gotten any complaints from the neighbors. The home was here even before the neighbors moved in and they are aware of the residents behaviors. COA also shared that the neighbor on the right side of the house has helped when one of the residents were throwing their clothing on their side. They understand the residents behaviors. LPA attempted to contact the responsible parties but was not able to get hold of them.

Based on records review, two residents (R1 & R2) both have yelling behavior. Staff are provided with de-escalation techniques to do when behavior arises. For R1, staff are to remain calm, maintain a quiet voice and keep control of emotions, back away from R1 and refrain from making eye contact and give R1 time and space to calm down. For R2, its to ensure that R2 has access to his/her cell phone and/or laptop computer. Being engaged with these items keeps R2 focused and he/she is generally calm.

Based on interviews and records review, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025

LIC9099 (FAS) - (06/04)

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