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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202205
Report Date: 05/16/2025
Date Signed: 05/16/2025 02:36:10 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
04/17/2024 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20240417164042
FACILITY NAME:SANTOS CARE HOMEFACILITY NUMBER:
435202205
ADMINISTRATOR:MICHELLE S. SANTOSFACILITY TYPE:
735
ADDRESS:1706 MT. RANIER AVE.TELEPHONE:
(408) 469-7154
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:6CENSUS: DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Licensee/Administrator, Michelle SantosTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Resident sustained fractures at the facility due to staff neglect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Licensee/Administrator, Michelle Santos and stated the purpose of today’s visit.

On 4/17/2024, the Department received a complaint with the above allegations. On 4/23/2024, the Department conducted an initial investigation at the facility. On 4/17/2024, resident (R1) was hospitalized and was assessed by skilled professionals that R1 had sustained fractures which were healing prior to admission to the hospital.

On 4/15/2024, the Department received an Incident Report for this incident which occurred on 4/14/2024. Per Report, R1 was sent to the hospital to require medical attention related to R1’s breathing.

Continuation on LIC 9099-C, Page 1 of 3.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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 2
Control Number 26-AS-20240417164042
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: SANTOS CARE HOME
FACILITY NUMBER: 435202205
VISIT DATE: 05/16/2025
NARRATIVE
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Page 2 of 3.
Per Report, R1 was seen by primary care physician on 12/5/2023, 1/15/2024, 2/16/2024 and 3/6/2024 and physician did not note any skin issues or medical issues related to resident sustaining a fracture.

On 4/23/2024, LPA Rai interviewed 3 staff. Three out of three staff stated they have been present in the facility to provide care and supervision to the staff and there hasn’t been an incident wherein there is no staff present at the facility. S1 and S2 were present at the facility on 4/14/2024 when they took R1 to the Emergency Room at the hospital. All three staff stated they have not observed R1 to have any injuries that would be related to a fracture and all three were surprised to hear about R1 sustaining a fracture. S1 stated R1 had been seen by the primary care doctor and per doctor’s notes, there were not issues with skin which would indicate R1 had an injury.

On 4/23/2024, LPA Rai interviewed 5 residents (R1-R5), but 4 residents (R2-R5) were not able to verbally or physically communicate with LPA. R1 stated facility staff are always present at the facility and cannot recall a time where staff were not present at the facility. R1 stated there hasn’t been an incident where a resident fell and staff were not aware. R1 stated when residents require care or assistance, the facility staff are present at the facility to help.

Based on review of R1’s facility file, R1 has medical diagnosis which would make R1 more susceptible to having increased risk of fractures caused by falls. Facility staff did monitor resident from the last medical appointment on 3/6/2024 and facility staff did not observe any medical concerns which would cause a fracture. Based on review of facility’s LIC 500 Personnel Report, there are 2-4 staff on schedule from 8am to 9pm every day and from 9pm to 8am, there are at least 1 wake care staff to supervise and provide care to the residents.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee/Administrator, Michelle Santos and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2