435202424-9-13-2023-26-AS-RMAO-CVUMQ2-20230920094800

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202424
Report Date: 09/13/2023
Date Signed: 09/13/2023 04:26:29 PM

Unfounded

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
02/24/2022 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20220224164457

FACILITY NAME:	CASA LAUREL		FACILITY NUMBER:	435202424
ADMINISTRATOR:	SOL SAMONTE		FACILITY TYPE:	740
ADDRESS:	680 NORTH 18TH ST.		TELEPHONE:	(408) 287-4541
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	6	CENSUS:	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator Samonte		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff exposed himself/herself to resident

INVESTIGATION FINDINGS:

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LPA Monter conducted an unannounced visit to deliver findings of the above allegation. Met with Administrator Samonte.

On 02/25/2022, the Department conduct an initial inspection/investigation wherein copies of resident's (R1) files were reviewed and obtained.

On 7/26/2023, the Department conducted a subsequent interview with Administrator (ADM) on the phone. ADM stated that when he/she was informed of this complaint, ADM spoke to resident (R1) about the allegation. ADM stated R1 saw a staff (S1) with a towel wrapped around his/her waist line when going in the bathroom but did not expose himself/herself to R1. ADM stated that S1 has been employed at the facility for a long time with his/her spouse. ADM stated that there was not a time where S1 was left alone with residents, nor S1 has a history of indecent exposure.
Continuation, page 1. See page 2 of 2.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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-20220224164457

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: CASA LAUREL	FACILITY NUMBER: 435202424
	VISIT DATE: 09/13/2023

NARRATIVE

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On 07/26/2023, the Department conducted a phone interview with staff (S2), S2 stated that he/she never observed staff exposing himself/herself to residents, nor seen S1 expose himself/herself to residents. S2 stated that his/her spouse did not expose himself/herself since they both resides live-in. S2 stated that S1 is his/her spouse.

On 08/25/2023 at 10:11 AM, the Department conducted a phone interview with staff (S1), S1 stated that he/she has been working at this facility since 1998. S1 stated there are 3 staff working for this facility, 2 female and 1 male staff. S1 stated that he/she has not observed staff being naked or exposing himself/herself towards residents. S1 stated that his/her spouse and him/her works 5 days a week, live-in. S1 stated that he/she takes a bath in the facility but does not expose himself/herself to residents or anyone. S1 stated that the staff room to the bathroom is about 2-3 step away. S1 stated that he/she does not get out of staff room naked to use bathroom. S1 stated that he/she lives with his/her spouse but he/she is even shy being naked in front of his/her spouse more so to residents. S1 stated that R1 has a history of accusing staff at the facility with no validity due to his/her mental illness. S1 stated that he/she has not been accused by staff or residents since he/she began his/her employment in 1998.

On 09/13/2023, LPA Monter interviewed 3 out of 3 staff. All staff members interviewed stated they have not seen other staff members naked. All staff members interviewed stated they have not heard the residents make complaints or mention staff being naked in front of them. LPA interviewed 2 out of 2 residents. Residents interviewed stated they have not seen staff naked at the facility or have heard anyone complain/ mention naked staff. Resident R1 did not want to be interviewed. 1 resident was not interviewed due to language barrier.

LPA reviewed R1's physicians report, sign and dated 01/04/2022. The physicians report states R1 has mental illness. LPA also reviewed R1's Appraisal/Needs and services plan, signed and dated, 01/07/2022. The for states R1 struggles with mental illness.

This agency has investigated the complaint allegations listed. Based on interviews, review of records, the CCLD has found that the complaint allegations are UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted with Administrator Samonte, and a copy of this report provided. Staff member Eluminada Yap signed on ADM's behalf.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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