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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202503
Report Date: 10/17/2023
Date Signed: 10/17/2023 05:04:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/20/2022 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20220120131853
FACILITY NAME:HEALTHY LIVING RESIDENTIAL CARE HOMEFACILITY NUMBER:
435202503
ADMINISTRATOR:MADELINE TAM CHOWFACILITY TYPE:
740
ADDRESS:251 DELIA STREETTELEPHONE:
(408) 493-6955
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:0CENSUS: 0DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Randel ChowTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff engaged in an inappropriate relationship with a resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Steve Chang and Manuel Monter conducted a complaint investigation visit to deliver investigation finding. LPA met with Administrator Randel Chow of facility Health Living (RC).

On January 20, 2022, the Department received a complaint with the above allegations that staff engaged in an inappropriate relationship with a resident in care.

On January 25, 2022, Initial investigation visit was conducted. Ms. Chen (S1) and resident (R1) were interviewed, residents/staff roster and resident documents were obtained.



Continue on LIC9099-C. Page 1 of 3.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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 6
Control Number 26-AS-20220120131853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: HEALTHY LIVING RESIDENTIAL CARE HOME
FACILITY NUMBER: 435202503
VISIT DATE: 10/17/2023
NARRATIVE
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Staff engaged in an inappropriate relationship with a resident in care:

On January 25, 2022, LPA met and interviewed S1 including inspection of the facility. During the facility inspection, LPA was informed that S1 and R1 were sharing a bedroom. The bedroom was observed equipped with a queen size bed. S1 stated he/she and R1 were engaged.

Prior to S1 engagement to R1, he/she worked as a volunteer so she/he can learn how to operate an RCFE facility. While S1 was working at the facility, S1 met R1 who was a resident of the facility and subsequently fell in love.

On May 24, 2023, the Department conducted a follow up interview with S1. S1 stated in August 2021 he/she visited the facility with his/her relator; S1 was interested in purchasing a residential care home. S1 stated while visiting and touring the facility property, he/she met resident R1. S1 stated that in mid-August 2021, S1 worked at the facility as a volunteer because he/she wanted to learn how to run a care home. S1 stated that he/she was allowed by Licensee, Madeline Chow (MC) to work at the facility.

S1 stated R1 was placed in the facility because R1 lived alone by himself/herself and was unable to provide care for self and required supervision. In October 2021, S1 took over the facility as the Administrator and subsequently thereafter, he/she S1 obtained his/her RCFE license for Senior Sweet Care Home on March 22, 2022. S1 stated he/she lived with R1 together in a room in the facility. They were engaged in January 2022, and they got married in February 2022.

On May 25, 2023, the Department interviewed Licensee. Madeline Chow (MC). MC stated he/she met S1 during the tour of his/her facility because ADM was interested in owning a RCFE facility. MC stated that prior to R1’s admission to the facility, R1 was assessed and deemed to have neurocognitive disorder who requires care and supervision.

Continue on LIC9099-C. Page 2 of 3.

SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 26-AS-20220120131853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: HEALTHY LIVING RESIDENTIAL CARE HOME
FACILITY NUMBER: 435202503
VISIT DATE: 10/17/2023
NARRATIVE
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MC stated that he/she relinquished the facility operation to S1 on October 2021. Since MC sold the ‘business’ (care home) to S1, he/she did not know that R1 and S1 developed a relationship in the facility and sharing a bedroom not until January 2022.

The licensee (MC) had no knowledge of R1 and S1 intimate relationship hence he/she relinquished the operation of the facility to S1 in October 2021 with a new lease back agreement.

Based on observations, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED.

Citations are being cited. See LIC 9099-D.

Exit interview conducted with RC. The report was provided to RC for signature. A copy of this report was provided to RC. Appeal Rights were provided.

Page 3 of 3.

SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/20/2022 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20220120131853

FACILITY NAME:HEALTHY LIVING RESIDENTIAL CARE HOMEFACILITY NUMBER:
435202503
ADMINISTRATOR:MADELINE TAM CHOWFACILITY TYPE:
740
ADDRESS:251 DELIA STREETTELEPHONE:
(408) 493-6955
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:0CENSUS: 0DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Randel ChowTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Resident is being financially abused.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Steve Chang and Manuel Monter conducted a complaint investigation visit to deliver investigation finding. LPA met with Administrator Randel Chow (RC).

On January 20, 2022, the Department received a complaint with the above allegation that Resident is being financially abused.

On January 25, 2022, Initial investigation visit was conducted. Xiuyan Chen (S1) and resident (R1) were interviewed, residents/staff roster and resident documents were obtained.



Continue on LIC9099-C. Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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 6
Control Number 26-AS-20220120131853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: HEALTHY LIVING RESIDENTIAL CARE HOME
FACILITY NUMBER: 435202503
VISIT DATE: 10/17/2023
NARRATIVE
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Resident is being financially abused:

On January 25, 2022, LPA interviewed S1. S1 stated he/she owns his/her business and owns a home. S1 denied he/she financially abused resident R1 and spouse. S1 stated R1 own his/her own home and S1 helped R1 find a realtor to sell the house. S1 denied allegation that he/she is financially abusing R1.

S1 stated that R1 wanted to sell his/her house in which he/she hired the same realtor who helped him/her purchase his/her Adult Residential Care Home (ARF). S1 stated that the sale of R1's home did not materialize.

On January 25, 2022, LPA interviewed resident R1. R1 stated that S1 helped him/her to find a realtor to sell his/her house.



On May 24, 2023, the Department conducted a subsequent interview with S1. S1 stated that when he/she took over the facility on October 2021, R1 has not paid rent for 3 months. S1 also stated that R1 owed $12,000.00 for 3 months from the licensee.

S1 stated he/she did not charge R1 for monthly rent since he/she took over the care home in October 2021 to present including the amount owed to licensee.

S1 stated that after his/her marriage to R1, the issue about his/her marriage to R1 was and currently being investigated by the County of Santa Clara. S1 stated that he/she was accused of taking advantage of R1’s finances because R1 has Neurocognitive Disorder.

The department has investigated the above allegations. Based on the investigation and interviews conducted, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur.



No citations noted at today’s compliant investigation visit. Exit interview conducted with RC. A copy of this report was provided to RC.

Page 2 of 2.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 26-AS-20220120131853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: HEALTHY LIVING RESIDENTIAL CARE HOME
FACILITY NUMBER: 435202503
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2023
Section Cited
HSC
1568.082(3)
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1568.082 Suspension or revocation of licenses...(3) Conduct which is inimical to the health, welfare, or safety of either an individual in or receiving services from the facility...
This requirement is not met as evidenced by:
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Licensee stated he/she will submit a written statement of his/her understanding of the regulation regarding conduct inimical by POC date.
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Based on investigation conducted; S1 had a relationship with R1 who has neurocognitive disorder, which poses an immediate health, safety and personal rights of risk to a person in care.
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HSC
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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.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien ChangTELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6