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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202578
Report Date: 09/03/2025
Date Signed: 09/12/2025 07:06:57 AM

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
05/12/2025 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20250512173550
FACILITY NAME:CEDAR MANOR LLCFACILITY NUMBER:
435202578
ADMINISTRATOR:CASIM, ELVIRAFACILITY TYPE:
735
ADDRESS:415 HEATH STREETTELEPHONE:
(408) 945-9197
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:6CENSUS: 2DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Staff Golda MedinteTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Facility staff did not supervise resident resulting in sexual abuse of a resident by another resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced investigation visit to deliver the investigation finding and met with Staff Golda Medinte. (09/12/2025- This report is being amended due to erroneous error in LIC9099-D)

On May 12, 2025, the Department received a complaint alleging Facility staff did not supervise resident resulting in sexual abuse of a resident by another resident.

On May 13, 2025, LPA Steve Chang interviewed ADM. ADM stated there is no resident that requires a 1:1. ADM stated R1 and R2 are roommates. ADM stated she never received any report with similar incident before, and this is the first time.
Regarding the incident between R1 & R2, ADM stated R2 just suddenly rushed to R1 & kissed him/her. ADM stated S3 was in the kitchen and S2 was in the hallway. ADM stated when S2 witnessed this, he/she told R2 to stop. ADM stated the incident occurred too fast and staff unable to stop it. Page 1 Out of 4.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 5
Control Number 26-AS-20250512173550
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: CEDAR MANOR LLC
FACILITY NUMBER: 435202578
VISIT DATE: 09/03/2025
NARRATIVE
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ADM stated, regarding the incident between R1 and R3 occurred in R3’ bedroom. ADM stated, Staff S1 showed witness W1, R3’s bedroom. ADM stated as the bedroom door was being opened, R3 was going to kiss R1 and touched R1’s private area. S1 asked R1 to stop.

On June 4, 2025, LPA’s Chang and Rai interviewed residents R2 and R4. Both residents were unable to respond to LPA’s questions and/or did not want to provide answers to questions posed.

LPA Chang and Rai interviewed staff S1 and S4. S1 stated he/she has witnessed times when R2 has tried to kiss R1. S1 stated he/she has not seen or heard of residents touching each other’s privates. S1 stated resident R2 is easily re-directed, he/she will listen to the staff.

S4 stated he/she was not present when the incidents occurred. S4 stated R2 has tried to kiss the other residents before and the staff will redirect R2, by saying R2 should not kiss unless the other residents want to. S4 stated he/she hasn’t seen resident R3 try to grab other residents’ privates.

On July 11 & 14, 2025, LPA Manuel Monter interviewed staff S1 and S2. Staff S1 stated he/she opened R3’s bedroom door and saw R1 kiss R3. S1 stated the kissing only occurred for a few seconds and he/she told the residents to stop. S1 stated it happened so fast and couldn’t intervene to stop it from happening. S1 stated he/she didn’t see either resident touching each other’s privates. S1 stated he/she didn’t observe R2 kiss R1.

S2 stated saw he/she went to R2’s bedroom and opened the bedroom door. S2 stated as he/she stated R2 kissed R1 for just second. S2 stated they only touched lips and he/she told them not to do that. S2 stated he/she didn’t observe R3 kiss R1. Staff S3 stated he/she has observed resident R2 and R3 attempting to kiss other residents in the past.

On July 24, 2025, Licensing Program Analyst Manuel Monter interviewed residents R1 and R3. Both residents interviewed were unable to provide answers to LPA's questions. Residents interviewed had behaviors such as not talking, or engaging in other actions such as playing with toy/eating etc.

Page 2 Out of 4
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20250512173550
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: CEDAR MANOR LLC
FACILITY NUMBER: 435202578
VISIT DATE: 09/03/2025
NARRATIVE
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On August 14 and 26, 2025, LPA Monter interviewed staff S1, S3 and S5. S1 stated resident R1 has the following behaviors. R1 will go to R2’s bedroom and lay down on R2’s bed. S1 stated he has witnessed R1 kissing R2. S1 stated if you don’t watch R3, he/she will go to R2’s bedroom and start kissing R2. S1 stated R1 and R3 have similar behaviors of entering R2’s bedroom and attempting to kiss R2. S1 stated he has seen this kissing behavior from R1 and R3. S1 stated this behavior has been occurring for more than 2-3 years ago. S1 stated S5 is aware of what S1 has witnessed. S1 stated S5 has also witnessed the kissing events. S1 stated S5 has told them that it’s a normal behavior of the clients. S1 stated he/she informed S5 of the behaviors.

S3 stated about a year ago, was when R1 and R3 were exhibiting the kissing behaviors. S3 stated the R1 and R3 kiss in the morning and afternoon. S3 stated the kissing happens over 10 times in a month. S3 stated she reported it to S5. S3 stated S5 told him/her regarding the residents kissing, that its normal, and part of their behaviors. S3 stated R1 and R3 have similar kissing behaviors. S3 stated they kiss on the lips, like lovers. S3 stated S5 has also observed the kissing behaviors.

S5 stated he/she is not aware of any inappropriate behavior between residents. S5 stated nothing has been reported to him. S5 stated regarding kissing behavior, that its an old behavior. S5 stated this behavior has been occurring with R1, R2 and R3. S5 stated these residents will kiss the back of the staff when they come in for a hug. S5 stated he/she did not tell the ADM about the residents kissing the staff in the back and shoulder area when hugging from behind or side. S5 stated when this happens, he/she talks to the residents, but they cannot understand. S5 reiterated that he/she has never observed residents kissing in lips.

On August 21, 2025, LPA Monter interviewed ADM. ADM stated she knows R1 and R2 hug, but haven’t seen them kissing. ADM stated staff haven’t told her about any incidents of kissing. ADM stated R1 doesn’t kiss the staff. ADM stated resident R3 would try to kiss the staff in the back, neck and or shoulder area. ADM stated R3 will kiss the staff, upper back, maybe the neck. ADM stated R3 Tries to kiss staff without them noticing. ADM later clarified that she made a mistake, and when he/she was talking about R3, she made a mistake. ADM stated resident R5 has the kissing the staff in the back, neck shoulder area.

Page 3 out of 4
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 26-AS-20250512173550
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: CEDAR MANOR LLC
FACILITY NUMBER: 435202578
VISIT DATE: 09/03/2025
NARRATIVE
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The Department reviewed 3 incident reports for the residents R1-R3. The Department reviewed 3 incident reports for the residents R1-R3. The incident report stated, on May 6, 2025, around 3pm, ADM met with service coordinator (SC). SC mentioned that he/she noticed R1 was harassed by two individuals in the home. One hugged him/her and forced him/her to kiss in the mouth, while another individual grabbed him by his/her privates and kissed him/her in the mouth. Staff meeting was held immediately, and staff recalled the incident. Staff stated it happened so fast but tried to intervene by saying “no,no,no”, while another staff tried to intervene by saying, “don’t do that”.

The Department reviewed R2’s appraisal/Needs and Services Plan (ANS), dated April 1, 2025. The ANS states R2 has the following needs: Needs to be able to interact positively with other, Needs to express emotions/feelings appropriately.

The Department reviewed R3’s Appraisal/Needs and Services Plan (ANS) dated April 1, 2025. The ANS states R3 has the following needs: Needs to engage in group interaction and improve interpersonal relationships with peers, needs to express emotions/feelings appropriately.
The Department reviewed a special incident report dated June 18, 2025. The report states on May 6, 2025, it was observed that when in R2’s room, R2 initiated a hug with R1. While hugging R2 grabbed R1 by the chin and forced R1 into a kiss. A Witness intervened.

Based on a review of the investigation conducted; 4 Out of 5 staff interviewed (S1, S3-S5) stated residents R2 and & R3 behavior of kissing was a known behavior that has occurred in the past before the incident that occurred on May 6, 2025. Based on a review, Residents R2 and R3’s ANS does not detail how the facility address these behaviors, which resulted in R2 and R3 sexual abusing another resident
Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D. This report was reviewed with Administrator Mary Grace Lazaro via phone call. ADM stated staff Golda Medinte could sign on her behalf. A copy of the report was provided. Appeal Rights was provided.

Page 4 Out of 4. END OF REPORT.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 26-AS-20250512173550
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: CEDAR MANOR LLC
FACILITY NUMBER: 435202578
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2025
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement was not met as evidence by:
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Licensee stated to submit a Plan of Correction by the POC due date to train staff on providing care and supervision necessary to meet the residents needs. Once the training is complete, the Licensee agrees to submit copies of the training records to CCLD.
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Based on interviews and records reviewed, on 05/06/25, R2 and R3 kissed R1. Staff present in the facility stated they did not have a direct line of sight because this incident occurred in R2’s bedroom.
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( Continue) Staff stated R2's bedroom door was closed, and staff were unaware of what was occurring between residents R1, R2 and R3. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.
Type B
09/10/2025
Section Cited
CCR
85068.3(a)
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85068.3 Modifications to Needs and Services Plan (a) The written Needs and Services Plan specified in Section 85068.2 shall be updated as frequently … to document significant occurrences that result in changes in the client's physical… This Requirement was not met as evidenced by;
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ADM stated she will send a letter of understanding regarding the regulation.
ADM stated she will send the Plan of Correction by POC date
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Based on interviews and records reviewed, 4 Out 5 staff interviewed stated R2 and R3’s kissing behavior is a previously observed behavior since at least 6 months prior to this incident, and this behavior is not addressed in R2 and R3’s ANS.
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(Continue) This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5