435202417-6-27-2025-26-AS-KHOS-DJDL89-20250708083133

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202417
Report Date: 06/27/2025
Date Signed: 06/27/2025 03:29:10 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
06/19/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250619104620

FACILITY NAME:	BAYMILL CARE HOME		FACILITY NUMBER:	435202417
ADMINISTRATOR:	ZACARIAS, REMEDIOS		FACILITY TYPE:	735
ADDRESS:	2822 BAYSMILL COURT		TELEPHONE:	(408) 225-9672
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	6	CENSUS: 3	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Remedios Zacarias		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff engaged in a physical altercation with client in care
Staff damaged clients personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Remedios Zacarias.

On June 19, 2025, the Department received a complaint alleging Staff engaged in a physical altercation with client in care / Staff damaged clients personal property

On June 17, 2025, the Department received an incident report. The incident report (IR) stated on June 17, 2025, R1 had told staff about an incident that had occured at baymill care home. The IR states a staff member "hit him/her" and "put him/her on the floor" and threw his/her phone two times.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

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 3

Control Number 26-AS-20250619104620

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: BAYMILL CARE HOME	FACILITY NUMBER: 435202417
	VISIT DATE: 06/27/2025

NARRATIVE

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On June 17, 2025, the Department received an incident report, for an event that occurred on June 16, 2025 regarding resident R1. The IR stated around 2:30pm, R1 was upset. R1 attempted to push/hit the other residents, while they were listening to the radio in the dinning room. Staff S1 intervened and R1 threw his/her phone toward S1. R1 picked up his/her phone and went to his/her room.

On June 25, 2025, LPA Manuel Monter interviewed Witness W1-W3. Witness W1-W3 stated they were told regarding the alleged abuse that occurred in Baymill care home. W1-W3 stated they didn't observe any bruising or marks on resident R1.

LPA Manuel Monter interviewed resident R1. R1 stated on June 16, 2025, in the afternoon he/she was told to be quite. R1 stated staff S1 started hitting him/her. LPA asked R1 to describe how did staff S1 hit him/her. R1 stated he/she doesn't know and reiterated that S1 had hit him/her. R1 stated the staff person then took his/her phone and threw it two times breaking the phone.

On June 27, 2025, LPA Manuel Monter interviewed residents R2-R3. Resident R2 stated he/she remembers when resident R1 threw his/her phone. R2 stated R1 was upset and tried to hit him/her. R2 stated staff was in the kitchen and as the staff told him to stop, R1 threw his/her phone. R2 stated R1 threw the cell phone. R2 stated the staff did not throw the phone or hit R1. LPA attempted to interview resident R3. R3 was unable to provide answers to LPA's questions, was ignoring LPA's questions and walked away from LPA.

LPA interviewed staff S1. S1 stated on June 16, 2025, he/she was in the kitchen when R1 had arrived from the day program upset. S1 stated R1 then went to his/her bedroom and was banging his/her bedroom door. S1 stated R1 then came to the kitchen and began cursing at R2 and tried to push R2. (Resident R2 and R3 were in the dinning room, which is directly next to the kitchen.) S1 stated he/she told R1 to stop and as he/she was walking towards, resident R1 threw his/her phone at S1. S1 stated R1 picked up his/her phone and went to his/her room. S1 denied hitting or touching R1. S1 denied throwing R1's cell phone.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250619104620

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: BAYMILL CARE HOME	FACILITY NUMBER: 435202417
	VISIT DATE: 06/27/2025

NARRATIVE

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LPA interviewed ADM. ADM stated, she was not in the facility when the incident occurred. ADM stated she only knows what staff S1 and what the other resident had told her. ADM stated her staff didn't hit R1 or throw R1's phone. ADM stated she also went to assess resident R1 and did not see any bruising or marks on resident R1.

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.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

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