435202261-4-13-2023-26-AS-VHEG-CSCVGT-20230531162601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202261
Report Date: 04/13/2023
Date Signed: 04/13/2023 09:25:19 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
10/07/2022 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20221007162948

FACILITY NAME:	MISSION BAY LAS COLINAS		FACILITY NUMBER:	435202261
ADMINISTRATOR:	MARIA COKER		FACILITY TYPE:	775
ADDRESS:	50 LAS COLINAS LANE		TELEPHONE:	(408) 661-4883
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95119
CAPACITY:	177	CENSUS: 161	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Dennis Miclat		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Client was sexually abused while in care of the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding of the above allegation. LPA met with Program Director, Dennis Miclat.

On 10/07/2022, the Department received the complaint. This complaint was accepted as a full investigation by the Department’s Investigations Bureau. On 10/11/2022, the initial complaint investigation was conducted by LPA Dolores.

The following documents were obtained throughout the investigation to include client roster, personnel report, staff daily schedule for September 2022, R1 – R5’s physician’s report, needs and services plan, R1’s emergency form, IPP, Behavior Support Plan, functional capability assessment, incident report, and police report. SEE LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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-20221007162948

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 LAS COLINAS	FACILITY NUMBER: 435202261
	VISIT DATE: 04/13/2023

NARRATIVE

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Based on investigation, interviews with staff at the day program revealed that clients are always supervised while they use the restroom. No clients are allowed to go to the restroom alone and staff stand outside the restroom door until the client is done. Client (C1) gave a description to the Police Department of a male that sexually abused him/her but the story changed and was inconsistent. C1 was unable to provide a consistent detail about what occurred. C1 provided a name and descriptions of the alleged abuser, however, there were no person that fit that description at the day program. The only person who fit the stated name was the opposite gender than what was described.

Multiple interviews revealed C1 has made similar allegations that has not been proven true. An interview with C1’s service coordinator revealed C1 has made similar allegations in the past but has admitted to lying about those allegations.

Based on interview, record review, and observation the Department has investigated the above allegation to be UNSUBSTANTIATED. An unsubstantiated finding means although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Program Director, Dennis Miclat and a copy of the report was provided.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

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