435202261-12-12-2024-26-AS-KHOS-DCJJUZ-20250102062223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202261
Report Date: 12/12/2024
Date Signed: 12/12/2024 11:02:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2022 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 26-AS-20220524130134

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: 173	DATE:	12/12/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator Dennis Miclat		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are physically abusing clients
Administrator not qualified
Administrator is not reporting abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Dennis Miclat and explained the reason for the visit. Census: 173

Staff are physically abusing clients - LPA Lund reviewed facility records, interviewed staff, and clients in care. Based on facility records review, interviews with staff, and residents in care. LPA reviewed Abuse, Neglect, and Exploitation in the Elder Care Setting for management and Abuse and Neglect for staff. Staff interviewed stated “That they have never witnessed any staff physically abusing any clients in care and would notify management immediately if seen”. Clients interviewed stated “They feel safe and like the day program”.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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-20220524130134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: MISSION BAY LAS COLINAS	FACILITY NUMBER: 435202261
	VISIT DATE: 12/12/2024

NARRATIVE

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Based on facility records review, interviews with staff, and residents in care on the information provided, it was unclear if staff are physically abusing clients, therefore the allegation was deemed UNSUBSTANTIATED.

Administrator not qualified- LPA Lund reviewed facility records, and interviewed staff. Based on facility records review, and interviews with staff. LPA Lund reviewed Staff (S1) Completed the Adult Residential Facility Administrator Certification Program Standard Certificate 6049570735 Effective Date 9/18/2020 through Expiration Date 9/17/2022 & Staff (S2) Completed the Adult Residential Facility Administrator Certification Program Standard Certificate 6020508735 Effective Date 11/15/2022 through Expiration Date 11/14/2024. The certificates are issued in accordance with all applicable laws and regulations.

Based on facility records review, and interviews with staff on the information provided, it was unclear if administrator not qualified, therefore the allegation was deemed UNSUBSTANTIATED.

Administrator is not reporting abuse- LPA Lund reviewed facility records, interviewed staff, and clients in care. Based on facility records review, interviews with staff, and clients in care. The day program turns in Special Incident Reports (SIR) when any incident does happen. LPA reviewed SIR’s, Abuse, Neglect, and Exploitation in the Elder Care Setting for management and Abuse and Neglect for staff. Staff interviewed stated “That they have never witnessed any abuse if they have would report it to management”. Clients interviewed stated “They feel safe and like the day program”.

Based on facility records review, interviews with staff, and clients in care on the information provided, it was unclear if administrator is not reporting abuse, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC9099 (FAS) - (06/04)

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