435202261-10-13-2025-26-AS-ACON-DNJ2CA-20251117161626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202261
Report Date: 08/13/2025
Date Signed: 10/13/2025 09:08:11 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
06/04/2025 and conducted by Evaluator Marcela Yanez

COMPLAINT CONTROL NUMBER: 26-AS-20250604071134

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: 168	DATE:	08/13/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Dennis Miclat		TIME COMPLETED:	10:10 AM

ALLEGATION(S):

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Staff did not intervene between client physical interactions resulting in serious injury

INVESTIGATION FINDINGS:

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This report is amended
On 10/13/25 Licensing Program Analyst Marcela Yanez conducted an unannounced complaint investitagion visit to amend a complaint findings. LPA met with Dennis Miclat and announced the purpose of the visit
On 08/13/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced visit to deliver the findings of the complaint investigation of the above allegation, and met with Dennis Miclat Program Director and LPA stated the purpose of the visit.
On 06/04/2025, the Department received a complaint alleging that staff did not intervene between two clients’ physical interaction which resulted in serious injury.

On 06/04/25 LPA Fortes conducted an initial complaint investigation visit and obtained pertinent documents.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

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-20250604071134

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: 08/13/2025

NARRATIVE

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This report is being amended based on additional information received by the Department

On 06/02/25 upon returning to the facility from pick up S1, turned off the vehicle and S1 exited the van to help C1 exit the van, while exiting, C1 accidentally placed his/her left hand on C2. C2 then grabbed C1s hand and bit into C1s left pinky. S1 and S2 stated that the incident happened so quickly but were able to instruct C2 to stop biting C1s pinky. Based on documentation C2 has a history of physical aggression when presented with a non-preferred situation.

Based on the document review the incident happened on 06/02/2025. Based on investigation, S1 and S2 arrived at the facility with the clients. S2 turned off the vehicle and S1 proceeded to exit the van while assisting C1. While exiting, C1 unintentionally placed his/her left hand on C2. C2 then grabbed C1s hand and bit C1s left pinky. “Everything happened really fast” according to S1. S1 and S2 were able to instruct C2 to stop biting C1s pinky. S2 stated he/she turned back around to turn off the air conditioner when S2 heard a commotion and saw C1 crying and blood coming from C1s hand. S2 stated he/she did not witness the event and learned about what happened when 911 was called.
Based on document review, C2 has a history of physical aggression when presented with a non-preferred situation. Based on the law enforcement report, C1 accidentally placed his/her hand on C2s shoulder, C2 then bit C1s pinky.

On 07/24/2025, the Department concluded its investigation.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are 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 allegations did or did not occur.

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

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End of Report

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

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