435202461-5-27-2026-26-AS-RMAO-DURJNM-20260605071209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202461
Report Date: 05/27/2026
Date Signed: 05/27/2026 12:05:43 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
04/15/2026 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20260415083551

FACILITY NAME:	LAUREL LODGE		FACILITY NUMBER:	435202461
ADMINISTRATOR:	MERLE M. LAUREL		FACILITY TYPE:	740
ADDRESS:	2247 SERRA AVE.		TELEPHONE:	(408) 260-6880
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	6	CENSUS: 5	DATE:	05/27/2026
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Staff Eugene de Leon.		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility staff hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Staff Eugene de Leon. LPA went over report with ADM Merle via phone call. ADM stated staff Eugene de Leon could sign on her behalf.

On April 15, 2026, the Department received a complaint alleging Facility staff hit resident. It has been alleged that a staff member punched a resident in the lips.

April 20, 2026, the Department interviewed Witness W1. W1 stated on April 13, 2026 he/she observed R1 had an injury on his/her lip. W1 stated he/she asked R1 what had happened. R1 stated staff S1 had punched him/her. W1 asked R1 follow up questions regarding this incident. W1 stated, R1 said he/she doesn’t know why S1 punched him/her or when it happened. W1 stated, R1 also said that he/she doesn’t remember.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

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-20260415083551

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: LAUREL LODGE	FACILITY NUMBER: 435202461
	VISIT DATE: 05/27/2026

NARRATIVE

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On April 21, 2026, Licensing Program Analyst Manuel Monter, interviewed residents R1-R5. 5 out of 5 residents (R1-R5) stated they are not aware of any instance where a resident hit another resident. 4 Out of 5 residents (R2-R5) stated they are not aware of any instance where a staff hit another resident.

R1 stated staff S1 hit him/her in the lip, in the dinning room about 2 weeks ago. R1 stated staff S2 had observed this. R1 stated the other residents did not see this. R1 stated he/she thinks this happened in the morning. R1 stated S1 punched him/her as he/she was standing next to the dinning room table. R1 stated he/she didn’t fall. Note during the interview with R1, R1 made these statements while chuckling.

On April 21, 2026, Licensing Program Analyst Manuel Monter, interviewed staff S1 and S2. S1 stated about 2 weeks ago, R1 had injured his/her teeth. S1 stated R1 had bitten his/her lip, causing a little bit of bleeding and bruising. S1 stated that morning R1 told him/her and S2 that he/she had bitten his/her lip. S1 stated they wiped the area clean and provided first aide. S1 stated there hasn’t been any instance where staff hit a resident. S1 stated he/she never hit/punched any resident. S1 stated that hasn’t occurred.

Staff S2 stated about 2 weeks ago, in the morning, R1 had told him/her and S1 that his/her lip was bleeding. S2 stated R1 told him/her, that he/she had bitten his/her lip. S2 stated he/she saw that R1’s lip was bleeding. S2 stated when he/she saw the lip, it was bleeding and S1 cleaned up the area. S2 stated he/she never saw staff S1 hit any resident including R1.

On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator Merle Laurel. ADM stated, on April 8, 2026, she was informed by her staff that R1 had injured her lip, which resulted in some bleeding. ADM stated she went to the facility the next day. ADM stated she observed the injury as a small pin point size. ADM stated there wasn’t any bruising, just the point where it bleed. ADM stated she has not observed or is aware of any instance where a staff member hit a resident in care. ADM stated the staff are trained and know they cannot hit the residents. ADM stated her staff don’t hit the residents.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20260415083551

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: LAUREL LODGE	FACILITY NUMBER: 435202461
	VISIT DATE: 05/27/2026

NARRATIVE

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On May 15, 2026, Licensing Program Analyst Manuel Monter interviewed witness W2. W2 stated he/she only remembers that he/she visited the home (a day or two after the alleged incident) and was informed that R1 had injured him/herself by biting his/her lip. W2 stated the bruise was smaller than a dime. W2 stated he/she didn’t believe it warranted R1 being sent to the hospital due to its small size. W2 stated he/she doesn’t remember what R1 told him about the injury.

On May 26, 2026, Licensing Program Analyst Manuel Monter interviewed staff S3. S3 stated she did not work the day the incident occurred with resident R1. S3 stated he/she isn’t aware of any resident hitting, striking or throwing things at R1. S3 stated he/she is not aware of any instance where R1 sustained a fall. S3 stated is not aware of any instance of any staff hitting, striking or throwing things at R1.

The Department reviewed R1’s Appraisal Needs and Services Plan (ANS), dated January 1, 2026. The ANS states, R1 has neurocognitive impairment and has a history of biting him/herself, and scratching him/herself.

The Department reviewed R1’s Progress Notes dated March 1, 2026- April 20, 2026. Progress note dated April 8, 2026 states, at 8:45am when R1 brush his/her teeth, he/she called staff regarding his/her lip bleeding. Staff got alcohol and cotton to stop bleeding.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

LIC9099 (FAS) - (06/04)

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