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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202473
Report Date: 12/10/2025
Date Signed: 12/10/2025 01:57:05 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
08/22/2025 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20250822142752
FACILITY NAME:VILA VICTORIA #1FACILITY NUMBER:
435202473
ADMINISTRATOR:MR. CYRIL INNEHFACILITY TYPE:
735
ADDRESS:393 E. SAN FERNANDO STREETTELEPHONE:
(408) 271-9244
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:23CENSUS: DATE:
12/10/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cyril InnehTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Staff did not issue a refund to resident's responsible party
INVESTIGATION FINDINGS:
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On 12/10/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver the findings. LPA met with Cyril Inneh, Administrator (ADM). LPA announced the purpose of the visit.

On 08/22/25 the department received a complaint alleging the facility did not issue a refund to the resident’s responsible party.

On 08/27/25 LPA Yanez conducted an initial 10-day complaint visit and obtained pertinent resident documents, resident roster, and rent ledger and facility bank documents and interviewed ADM.
ADM stated that the facility upon a residents demise the facility notifies the conservator, responsible party and payee.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
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-20250822142752
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: 12/10/2025
NARRATIVE
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ADM provided a ledger of the rental income received for residents and the residents’ name was removed after resident passed away on 05/24/2024 and no rental payment was logged. LPA requested copies of facility bank statement and the resident’s payee submitted payments from 05/2024 to 01/2025 that were directly deposited to facility bank account. ADM stated he was not aware the facility was still receiving payments.

RP stated that the facility was sent a letter of demand dated 01/17/25 stating the facility has been receiving payments for resident’s rental fee and Personal and Incidental income (P&I). The Payee requested the facility to reimburse for a total of $11,696.50 for rental income and P&I money. The facility did not immediately respond to the letter of demand.

The payee continued to request a refund for fees charged from 05/2024 to 01/2025 for the full amount due. The refund was paid on 08/28/25. ADM provided copy of cashiers check dated 08/28/25 for the total amount of $11,696.50 that was delivered and stamped by payee.

The department completed its investigation and determined based on records review, interviews and observations there is preponderance of evidence to prove the alleged violation did occur; therefore, the allegation is substantiated. See 9099-D for deficiencies cited per the California Code of Regulations, Title 22.

This report was reviewed with ADM Cyril Inneh and a copy of report and appeals rights were provided.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20250822142752
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: 12/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2025
Section Cited
CCR
80022(a)(11)
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80022 Plan of Operation (a) Each licensee shall have and maintain on file a current, written, definitive plan of operation.(11) Rate setting policy including, but not limited to, policy on refunds.
This requirement is not met as evidenced by:
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Deficiency is cleared during visit ADM provided payment of rental income and Personal and Incidental money for the amount due to payee on 08/282/25. ADM provided copy of check issued to payee.
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Based on interview, record review and observation the licensee did not comply with the section cited above wherein Licensee did not provide a refund to residents R1s payee for payments made after resident passed away within 10 days per admission agreement policy
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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: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC9099 (FAS) - (06/04)
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