435202473-1-18-2023-26-AS-KHOS-CP2JWJ-20230214062445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202473
Report Date: 01/18/2023
Date Signed: 01/18/2023 01:37:00 PM

Substantiated

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
01/10/2022 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20220110151458

FACILITY NAME:	VILA VICTORIA #1		FACILITY NUMBER:	435202473
ADMINISTRATOR:	MR. CYRIL INNEH		FACILITY TYPE:	735
ADDRESS:	393 E. SAN FERNANDO STREET		TELEPHONE:	(408) 271-9244
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	23	CENSUS: 22	DATE:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Cyril Inneh		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff member sexually assaulted resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 01/10/2022, the Department received a complaint with the above allegation. The Department made an initial complaint investigation visit on 01/12/2022. The Department continued to investigate and conduct interviews at later dates. LPA Marrufo met with Administrator Cyril Inneh.

Resident R1 positively identified staff S1 twice as the suspect who raped R1. The facility’s camera footage showed S1 entering and exiting R1’s bedroom multiple times on 01/09/2022. A review of the footage showed S1 and R1 exiting R1’s bedroom, walking down to the second floor and S1 turning around and signaling to R1 to be quiet by putting S1’s finger to S1’s mouth. The video footage also shows S1 with S1’s belt unbuckled afterwards and S1 is seen adjusting S1’s pants walking down the stairs from R1’s bedroom.

See LIC9099-C for more information. Page 1 of 2.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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-20220110151458

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: VILA VICTORIA #1	FACILITY NUMBER: 435202473
	VISIT DATE: 01/18/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

S1 did not say anything to R1 during the rape, but R1 stated S1’s breath smelled of alcohol. Resident R2 stated to have observed S1 drinking beer in the facility kitchen earlier in the evening of the incident. S1 admitted during interview to drinking two beers at home prior to working and drinking a third beer at the facility. S1 stated to have consumed a beer thinking S1 was not going to be working that day.

R1 was immediately taken to have a sexual assault rape exam done. San Jose Police Department (SJPD) Detective D1 obtained a sample of S1’s DNA via buccal swab and the result concluded S1’s DNA matched the sample obtained from R1’s rape kit.

On 04/14/2022, the Department served exclusion orders to S1. On 05/10/2022, SJPD arrested S1.

Deficiencies have been cited as per California Code of Regulations Title 22. See LIC9099-D for more information.

An immediate civil penalty of $500 have been issued. The Department will consider whether further civil penalties will be issued.

This report was reviewed with Administrator Cyril Inneh and a copy of the report and appeal rights were provided.

Page 2 of 2.

END REPORT

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20220110151458

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: VILA VICTORIA #1	FACILITY NUMBER: 435202473
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/19/2023 Section Cited CCR 80072(a)(1)	1 2 3 4 5 6 7	80072(a)(1) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.	1 2 3 4 5 6 7	Licensee agrees to submit a Plan of Correction by POC date detailing how the licensee shall train staff on personal rights, including according dignity in their relationships with residents. Once the training is completed, the licensee shall
	8 9 10 11 12 13 14	This regulation was not met as evidenced by: Licensee did not ensure that staff did not accord dignity in their personal relationships with residents, as evidenced by staff S1 raped resident R1, which posed an immediate safety risk to residents in care. A $500 immediate civil penalty has been assessed.	8 9 10 11 12 13 14	submit copies of the training records to CCL and include the dates of training, names of staff trained, training topics, and name and qualifications of trainer.
Type A 01/19/2023 Section Cited CCR 80046(a)(1)(a)(2)	1 2 3 4 5 6 7	80046 Exclusions (a) An individual can be prohibited from serving as a member of a board of directors, executive director, or officer; from being employed or allowing an individual in a licensed facility as specified in Health and Safety Code	1 2 3 4 5 6 7	Licensee agrees to submit a Plan of Correction by POC date detailing how the licensee shall train staff on the proper conduct to ensure health, morals, welfare, or safety of residents in care are safeguarded. Once the training is completed, the licensee shall submit
	8 9 10 11 12 13 14	Sections 1558 and 1558.1. (1) Health and Safety Code Section 1558 reads (a) The department may prohibit any person from being a member of the board of directors, an executive director, or an officer of a licensee, or a licensee from employing, or continuing the employment of, or allowing in a licensed facility, or allowing contact with clients of a licensed facility by, any employee, prospective employee, or person who is not a client who has: (2) Engaged in conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California. This regulation was not met as evidenced by: Based on interview and record review, Facility staff S1 sexually assaulted resident R1, which posed an immediate safety risk to residents in care.	8 9 10 11 12 13 14	copies of the training records to CCL and include the dates of training, names of staff trained, training topics, and name and qualifications of trainer. Staff S1 has been excluded by the Department.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3