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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202473
Report Date: 09/27/2024
Date Signed: 09/27/2024 04:49:18 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
03/18/2022 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20220318114218
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: 18DATE:
09/27/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Cyril InnehTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility fire alarm is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator (ADM) Cyril Inneh. On 03/18/2022, the Department received a complaint with the above allegation. On 03/25/2022, the Department conducted an initial complaint investigation visit.

On 03/22/2022, LPA Marrufo conducted an interview with a code enforcement inspector who stated that the fire marshal visited the facility in February 2022 and on 03/09/2022. The code enforcement inspector stated the facility smoke detector system was on standby but was not working with a green light.

On 03/25/2022, LPA Christine Dolores conducted an interview with Administrator (ADM) Cyril Inneh. During interview, ADM stated that ADM attempted to obtain a permit for the fire alarm from the city but was told that only the security company that ADM contracted to install the smoke detector system could request a permit from the city. ADM stated to have reached out to the security company multiple times. 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: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
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 4
Control Number 26-AS-20220318114218
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: 09/27/2024
NARRATIVE
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LPA Marrufo obtained copies of emails from ADM to the security company that ADM contracted to install and maintain the facility smoke detector system.

In an email from 11/13/2019 from ADM to employees of the security company, ADM states that ADM has not heard back from anyone at the security company and has received a violation notice and will have to pay a fine due to the security company’s negligence in the matter. ADM states that ADM went to the city of San Jose and tried to obtain a permit but was told only the security company can obtain a permit.

In an email from 06/30/2021 from the Operations Administrative Assistant of the security company to ADM, the Operations Administrative Assistant states that an employee of the company went to the city to re-issue a permit but “some additional items needed to be added,” and the employee still needs to do a walk through of the facility with an engineer. The Operations Administrative Assistant states, “I am very sorry this was not taken care of.”

In an email from 07/02/2021 from the Branch Project Manager of the security company to ADM, the Branch Project Manager states that the Branch Project Manager is requesting a “punch list items” that the city is requesting. The Branch Project Manager states that he/she will plan a site visit for the following week.

On 09/27/2024, LPA Marrufo conducted a telephone interview with a code enforcement inspector, who stated that the city government would only provide a fire alarm permit to the security company that maintains the fire alarm system and would not provide one to ADM.

Based on records review, interviews, and observations, 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 were cited under California Code of Regulations Title 22

This report was reviewed with Administrator (ADM) Cyril Inneh and a copy of this report was provided.

Page 2 of 2. END REPORT.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
03/18/2022 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20220318114218

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: 18DATE:
09/27/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Cyril InnehTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility modified balcony without notifying licensing agency
INVESTIGATION FINDINGS:
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On 03/22/2022, LPA Marrufo conducted an interview with a code enforcement inspector who stated that the fire marshal conducted a visit to the facility on 03/09/2022 and observed an extra pole that was added to the vertical post support of the balcony. The code enforcement inspector stated the extra pole was added without obtaining a permit. The code enforcement officer stated any additions to the balcony requires a plan to be submitted and for an inspection to be conducted.

LPA Marrufo obtained a copy of the letter written from the Department of Planning, Building, and Code Enforcement on 03/23/2022 that stated that permit for the balcony had expired without receiving a final inspection. On 03/25/2022, LPA Christine Dolores conducted an interview with Administrator (ADM) Cyril Inneh. During interview, ADM stated to not believe the Community Care Licensing Department was informed the facility was altered and balcony was built. Based on records review, interviews, and observations there is preponderance of evidence to prove the alleged violations 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 Administrator Cyril Inneh and a copy of this report was provided and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20220318114218
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: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/28/2024
Section Cited
CCR
80086(a)
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80086 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change.
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Licensee agrees to submit a notification to CCL by POC date of any current or planned construction or alterations to the facility property, including the facility balcony.
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 This requirement was not met as evidenced by: Licensee did not ensure that the licensing agency was prior to the alteration of the facility balcony, which poses an immediate safety risk to residents in care.
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The notification should include how the Licensee plans to work with city agencies and private contractors to obtain building permits and complete any construction or alterations to the facility.
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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: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4