435202403-2-16-2024-26-AS-RMAO-D2MUE6-20240220143038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202403
Report Date: 02/16/2024
Date Signed: 02/16/2024 02:13:55 PM

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
07/28/2023 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20230728140606

FACILITY NAME:	EBADAT RESIDENTIAL CARE HOME #4		FACILITY NUMBER:	435202403
ADMINISTRATOR:	DIOSDADO S. ARINES		FACILITY TYPE:	740
ADDRESS:	243 MARTINVALE LN.		TELEPHONE:	(408) 622-6293
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95119
CAPACITY:	6	CENSUS: 5	DATE:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:			TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident was sexually assaulted

INVESTIGATION FINDINGS:

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On 07/28/23, the Department received a sexual abuse complaint that a resident (referred as R1) was sexually assaulted by a staff (S1).
On 07/25/2023, at approximately 1140 hours, it was reported to law enforcement agency that a staff (referred as S1) gave R1 a goodnight kiss on the check and S1 grabbed R1’s head and kissed R1 on the lips.
Based on interview with R1, R1 stated that the incident occurred on 7/16/23. R1 stated that he/she was in his/her bedroom when he/she kissed S1 on the cheek. R1 giving S1 a goodnight kiss. After R1 kissed S1, S1 grabbed R1 and kissed him/her on the lips

R1 did admit to hugging and kissing the staff on the check. R1 usually gives good morning and goodnight kisses to the individuals that care for her/him. R1 stated that he/she did not give permission to S1 to kiss her/him, and he/she has not been in a relationship with S1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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-20230728140606

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: EBADAT RESIDENTIAL CARE HOME #4	FACILITY NUMBER: 435202403
	VISIT DATE: 02/16/2024

NARRATIVE

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Based on interview with R1’s spouse (SP1), SP1 stated that R1 gives kisses of good morning and good afternoon. SP1 stated that R1 told him/her that he/she had given S1 a goodnight kiss and that S1 grabbed him/her by the neck and kissed him/her occurred on 7/16/23.

Based on interview with Administrator (ADM) and Licensee (L), they were informed by R1’s spouse (SP1) that S1 grabbed and kissed R1. S1 stated the kiss was an “accident” and he/she accidentally turned his/her face and that they kissed. Facility staff informed SP1 that there have been multiple incidents where R1 had pinched them and touched their buttocks.

Based on interview with S1, S1 stated that he/she with spouse stayed on the couch in the evening though he/she did not live in the facility full time. S1 denied allegation that he/she had ever kissed R1 including a good morning or good night kiss. S1 also denied kissing R1 in his/her bedroom. S1 stated that sometimes R1 would come to him/her and give him/her a kiss on the cheek to say goodnight. S1 stated that prior week at about 2100 or 2200 hours, S1 was sitting on the couch and R1 sat next to him/her. R2 said, “Thank you” and kissed S1 on the cheek. S1 got startled and he/she turned to face him/her. S1 turned towards R1’s face, S1 stated that corner of his/her mouth have touched his/her face and the contact was not intentional. S1 recalled that R1 kissed him/her on the cheek when R1 had a seizure to thank him/her. S1 described it as a fatherly gesture as a thank you for his/her care and comfort he/she provided to R1. S1 stated that R1 also kissed other staff members on the cheek as a thank you.

On February 16, 2023, LPA interviewed 4 Out of 5 residents. 2 Out of 5 residents are non-verbal and could not respond to LPA's questions. 2 Out of 5 residents denied ever seeing staff touch or kiss residents in an inappropriate/sexual manner. 2 Out of 5 residents denied ever being touched or kissed by staff in an inappropriate/sexual manner. 1 Out of 5 residents was attending day program during LPA's visit.

LPA interviewed staff 4 staff members (S2-S5). 4 Out of 4 staff interviewed stated staff do not touch/kiss residents. 4 Out of 4 staff stated they have not seen other staff members touch or kiss the residents.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegation is 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.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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