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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202269
Report Date: 12/05/2025
Date Signed: 12/05/2025 09:24:37 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
09/03/2025 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20250903162458
FACILITY NAME:EVERGREEN GUEST HOME #1FACILITY NUMBER:
435202269
ADMINISTRATOR:EVELYN CANONIZADOFACILITY TYPE:
735
ADDRESS:3127 HAGA DR.TELEPHONE:
(408) 440-2887
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:6CENSUS: 4DATE:
12/05/2025
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Evelyn Canonizado, AdministratorTIME COMPLETED:
09:25 AM
ALLEGATION(S):
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Facility staff is not providing hygiene to resident in care
INVESTIGATION FINDINGS:
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On 12/05/25 Licensing Program Analyst Marcela Yanez conducted a complaint investigation visit to deliver complaint findings and met with Evelyn Canonizado, Administrator. LPA announced the purpose of the visit.

On 09/03/25 the department received a complaint with the above allegations.

On 09/11/25 the department conducted a 10-day initial complaint investigation visit.

During the investigation the department interviewed Staff (S1) and Administrator (ADM), and 3 residents (R1-R3).

R1stated the facility gives him/her showers daily and or gives partial showers when he/she doesn’t make it to the bathroom. R1 stated that the facility staff give him/her bed bath in between changing adult briefs, and the facility is attentive to his/her needs. R1 stated that the facility changes his/her clothing daily.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
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-20250903162458
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: EVERGREEN GUEST HOME #1
FACILITY NUMBER: 435202269
VISIT DATE: 12/05/2025
NARRATIVE
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LPA observed R1 to be clean and did not present any odor or did not look un-showered. R1 stated that he/she will occasionally not want to take a shower.

R2 stated that he/she gives his/her own showers. R2 stated that he/she takes a shower daily and the facility will ensure he/she does. R2 stated the facility staff help him/her with hygiene if needed.

S1 stated that the facility provides showers to residents daily and sometimes it is a bit difficult to give showers to R1 because he/she is heavy. S1 stated that if R1 does not want to shower he/she will give a bed bath. S1 stated that R1 had recently had a Urinary tract Infection and had a mal odor and was not due to facility not providing hygiene. S1 also stated that the facility is going to SARC training on "Signs and Symptoms of change in health condition". S1 stated that he/she always provides hygiene to R1 and R3.

Administrator was interviewed and he/she is aware of R1s hygiene regimen, and which residents need assistance with showers. ADM stated that R1 is constantly needing showers or bed baths because he/she wears adult briefs and sometimes may have an accident and when he/she doesn’t make it to the bathroom on time. ADM stated that he/she has instructed S1 to give R1 a half shower to thoroughly give a shower/rinse of the lower half of body when this occurs. S1 stated that the facility staff has always been attentive to R1s bathroom needs and hygiene. ADM stated that in the day program plan it states that the day program is supposed to assist R1 with changing adult brief and sometimes he/she returns to the facility with soiled briefs. ADM also stated that R4 is the only resident who does not like to take showers, and R1 likes to take showers. ADM stated this is the first time the Day Program R1 attends contacted them regarding R1s hygiene and R1 having an odor in the groin area. ADM stated that the day after the Day Program contacted the facility that R1 was diagnosed with a Urinary Tract Infection and the odor was due to infection.

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 Evelyn Canonizado and a copy of this report was provided.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
LIC9099 (FAS) - (06/04)
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