435202473-1-18-2023-26-AS-KHOS-CTLH6R-20230710055533

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202473
Report Date: 01/18/2023
Date Signed: 01/18/2023 03:27:34 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
12/23/2021 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20211223091144

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):

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Client exposed themself to another client.

INVESTIGATION FINDINGS:

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On 12/23/2021, the Department received a complaint with the above allegation. On 12/27/2021, the Department conducted a complaint investigation visit and interviewed 11 residents and Administrator Cyril Inneh. The Department conducted additional interviews with additional residents and staff at later dates.

The Department interviewed in total 11 residents, Administrator Cyril Inneh, 2 staff, and resident R1’s case manager. LPA Marrufo attempted to interview resident R1 during the initial complaint visit and during telephone calls to the facility on 03/30/2022 and 04/11/2022 but was unable to contact R1. Administrator stated during visit on 01/18/2023 that R1 had moved out of the facility on 05/31/2022 and provided LPA Marrufo with a copy of R1's lease termination letter.

6 residents stated to have never observed a resident expose themselves to another client. 5 residents stated to have observed a resident expose themselves to another client. See LIC9099-C for more information. Page 1 of 2.

Unsubstantiated

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 2

Control Number 26-AS-20211223091144

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

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Of the 5 residents who stated to have observed residents expose themselves to other residents, and 2 residents reported observing male residents walk exposed to their rooms from the shower.

Resident R2 stated sometimes he/she is naked in the bathroom, but it is not on purpose. R2 stated he/she uses a towel while changing in the bathroom shower stall and does not expose himself/herself on purpose. R2 stated that no one has accused him/her of exposing himself/herself in the shower.

Administrator (ADM) Cyril Inneh stated during interview that he encourages residents to shower every day. He stated he encourages female residents to use the single shower stall in the downstairs bathroom. He stated resident R1 reported to him that resident R2 exposed himself/herself to R1. ADM stated he interviewed R2, who stated to have used the bathroom sink and left without seeing R1.

2 out of 2 staff stated to have not observed or heard reports of a resident exposing themselves to other residents.

R1’s case manager stated to have been told by R1 that there was a male resident who exposed himself to R1 in the shower.

Based on information from interviews conducted with staff, and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated.

No deficiencies cited under California Code of Regulations Title 22.

This report was reviewed with ADM Cyril Inneh and a copy of the report was provided.

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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 2