435202288-1-2-2026-26-AS-CKAI-DQ7227-20260109160016

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202288
Report Date: 01/02/2026
Date Signed: 01/02/2026 10:34:59 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
10/17/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20251017160151

FACILITY NAME:	ELIM CARE HOME		FACILITY NUMBER:	435202288
ADMINISTRATOR:	MARK SUNG		FACILITY TYPE:	735
ADDRESS:	15600 LA MAR DRIVE		TELEPHONE:	(408) 771-6275
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	6	CENSUS: 5	DATE:	01/02/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Mark Sung		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Facility staff physically abused resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation visit to deliver the complaint findings. LPA met with Administrator (ADM) Mark Sung. LPA stated the purpose of the visit.

On 10/17/2025 the Department received a complaint, alleging facility staff physically abused a resident in care.

On 10/17/2025 LPA Manuel Monter interviewed Reporting Party (RP). RP states it was reported to him/her by Client (referred to as C1) that facility Staff S1 pulled C1’s hair on 10/12/2025, when C1 was ‘taking too long in the bathroom.’ RP states he/she did not observe any injuries (marks, or redness) to C1’s scalp.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026

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-20251017160151

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: ELIM CARE HOME	FACILITY NUMBER: 435202288
	VISIT DATE: 01/02/2026

NARRATIVE

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On 10/20/2025 and 10/21/2025 LPA Marcella Tarin interviewed 3 Witnesses (W1 to W3). 3 out of 3 Witnesses state C1 reported that he/she was pulled out of the bathroom by S1 on 10/12/2025. W1 states C1 has behaviors of fixating on imagined stains for up to 30 minutes at a time and must be prompted and re-directed by staff. W2 stated over the past two months, he/she has observed C1 to have increased behaviors of fixating on imagined stains in the bathroom and C1 not following redirection. W3 states he/she was unable to get accurate details from C1 about this incident. W3 stated C1 has behaviors of being fixated on objects/things and being non-compliant with re-direction.

On 10/21/2025 LPA interviewed 3 Staff (S1 to S3). 2 Out of 3 staff state he/she did not observe the incident on 10/12/2025. S1 stated on 10/12/2025 C1 told him/her there was vomit near the bathroom toilet. S1 stated he/she and C1 walked toward the bathroom, when C2 entered the bathroom. S1 stated C1 and C2 walked into the bathroom at the same time. S1 states he/she did not observe any vomit in the bathroom. S1 stated he/she asked C1 to leave the bathroom because C2 needed to use the bathroom. S1 stated he/she asked C1 for a few minutes to leave the bathroom, and C1 was not responding to his/her verbal re-directions. S1 stated he/she attempted to re-direct C1 by pulling him/her by the sweater because C1 was not responding to verbal prompts, and C2 needed to use the bathroom. S1 stated at no time did he/she have any contact with C1’s hair during this incident. S1 stated the facility has 2 bathrooms (upstairs and downstairs) available to clients.

LPA interviewed C2. C2 stated on 10/12/2025 he/she and C1 walked into the bathroom at the same time. C2 states he/she thought C1 was walking toward the kitchen, but C1 “walked right into the bathroom in front of me.” C2 states he/she told C1 to get out of the bathroom, and C1 stood in front of the toilet. C2 stated he/she kept telling C1 “Get out, I have to use the bathroom” and C1 did not respond. C2 states when S1 pulled C1 by the sweater, C1 pulled back and forth with S1. C2 stated there is another bathroom upstairs, but he/she prefers the downstairs bathroom.

LPA toured the facility and observed the facility has 2 client bathrooms, with one bathroom being located on the facility first floor, and the second bathroom located upstairs. LPA observed 2 client bathrooms to be functional and available to clients in care.

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SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20251017160151

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: ELIM CARE HOME	FACILITY NUMBER: 435202288
	VISIT DATE: 01/02/2026

NARRATIVE

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Based on review of C1’s Physician’s Report dated 7/28/2025, C1 has mental conditions that limit C1’s ability to follow directions due to confusion, and a visual impairment. Review of C1’s Care Plan dated 1/31/2025, C1’s communication skills are listed as “might misunderstand the conversation and can become irritable.” C1’s care plan ‘Supports at Home’ states C1 requires the use of a timer for the bathroom due to being in the bathroom for a “high volume of time.’

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED..

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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026

LIC9099 (FAS) - (06/04)

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