435202492-1-30-2026-26-AS-CKAI-DRW2YD-20260305164833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202492
Report Date: 01/30/2026
Date Signed: 01/30/2026 04:31:37 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
02/26/2025 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20250226153319

FACILITY NAME:	DYSICO CARE HOME, ARF		FACILITY NUMBER:	435202492
ADMINISTRATOR:	MARIA BONUAN		FACILITY TYPE:	735
ADDRESS:	787 E. SAN CARLOS STREET		TELEPHONE:	(408) 286-5364
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	6	CENSUS:	DATE:	01/30/2026
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:			TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff are unable to communicate with 911 personnel when asked to provide background information on a resident who requires medical attention.

INVESTIGATION FINDINGS:

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When the department received the complaint, it was alleged that when emergency responders arrived at the facility, facility staff could not provide R1’s information to the emergency responders and instead called the Administrator via Facetime to talk to the emergency responders.

On 01/23/2026, LPA Marrufo obtained a copy of the facility Program Design. The Procedures for Medical Emergencies section on page 23 of the Program Design states, “There shall be at least one person capable of and responsible for communicating with emergency personnel in the facility at all times.”

During visit on 01/14/2026, LPA Marrufo conducted telephone interviews with staff S1 and S2.

See LIC9099-C page for more information. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 26-AS-20250226153319

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: DYSICO CARE HOME, ARF	FACILITY NUMBER: 435202492
	VISIT DATE: 01/30/2026

NARRATIVE

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S1 stated during interview to have spoken with emergency responders when they arrived to the facility in response to R1’s seizure. S1 stated the emergency responders asked S1 what had happened to R1 and S1 replied that R1 had a seizure. S1 stated emergency responders asked S1 how long R1 seizure lasted and S1 stated it lasted five minutes. S1 stated that he/she provided emergency responders with a binder containing information about R1’s medication and other emergency information.

S2 stated during interview that when emergency responders arrived at the facility, they spoke with S1, S3, and the administrator. S2 stated he/she was looking for R1’s information binder so it can be given to the emergency responders.

During visit on 01/23/2026, LPA Marrufo conducted an interview with staff S3. S3 stated to not recall a time when emergency responders arrived at the facility to respond to R1’s seizures.

During visit on 03/06/2025, LPA observed there to be a binder labeled “Emergency Info (for 911 calls)” on the spine of the binder. The binder had a tab with R1’s name. The section behind R1’s tab included R1’s Emergency Contact Form, general facility contact information, and R1’s Primary Care Physician’s contact information.

During visit on 03/06/2025, Administrator Bonuan stated that when emergency responders arrived to the facility to respond to R1’s seizure, Administrator Bonuan was available to talk to the emergency responders via Facetime in case the facility staff were unsure of any of the emergency responder’s questions. Administrator Bonuan stated the staff understand English and can communicate with emergency personnel, but the staff may have been panicked at the time, so Administrator Bonuan made herself available to answer questions via Facetime.

Page 2 of 3.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 26-AS-20250226153319

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: DYSICO CARE HOME, ARF	FACILITY NUMBER: 435202492
	VISIT DATE: 01/30/2026

NARRATIVE

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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 violations 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 Eva Esposo and a copy of this report was provided.

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END REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 7