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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202626
Report Date: 08/21/2026
Date Signed: 08/21/2026 04:26:58 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
08/14/2026 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20260814153052
FACILITY NAME:EBADAT RESIDENTIAL CARE HOME # 5FACILITY NUMBER:
435202626
ADMINISTRATOR:CORONEL, AARON-DELLFACILITY TYPE:
740
ADDRESS:734 CHATSWORTH PLTELEPHONE:
(408) 334-8995
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:6CENSUS: 6DATE:
08/21/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator (ADM) Aaron-Dell CoronelTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility staff argued with one another in the presence of residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced initial complaint investigation. LPA met with Designated Staff Aileen Calicdan and Administrator (ADM) Aaron-Dell Coronel. LPA stated the purpose of the visit.

It has been alleged that facility staff argued with one another in the presences of residents in care.

During today's visit, LPA interviewed 4 Staff (S1 to S4), and 2 Residents (R1 to R2). 4 Out of 4 staff stated facility staff argued in the presence of residents in care on 8/9/2026. S4 stated Staff S3 and S5 argued with one another in the presence of residents in care on 8/9/2026. S4 stated he/she is aware that S5 had threatened to kill S3 while in the presence of residents in care.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026
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-20260814153052
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: EBADAT RESIDENTIAL CARE HOME # 5
FACILITY NUMBER: 435202626
VISIT DATE: 08/21/2026
NARRATIVE
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S3 stated on 8/9/2026, he/she and S5 were providing care to a resident, when his/her foot was injured/hurt by S5. S3 stated he/she told S5 to be careful, and S5 began to argue with S3, with S5 stating to S3 that he/she would 'kill' him/her. S3 stated facility management was informed of this incident, and he/she was told by facility management that S5 would be transferred to another facility due to this incident. S3 states S5 is still working at the facility.

LPA interviewed 2 Residents (R1 to R2). Resident R1 stated he/she has heard that S5 threatened to kill another staff member about two weeks ago. R1 stated he/she has heard S5 yelling at staff, that S5 yells that staff 'are not doing their job." R2 stated he/she did not have any issues or concerns.

Based on interviews conducted the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be SUBSTANTIATED. California Code of Regulations (Title 22), are being cited on the attached LIC 9099 D. An exit interview was conducted with the ADM Aaron-Dell Coronel and copy of this report was provided. Appeals rights also provided.

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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20260814153052
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: EBADAT RESIDENTIAL CARE HOME # 5
FACILITY NUMBER: 435202626
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2026
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

This requirement was not met as evidenced by:
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ADM states he will submit a plan of action to ensure staff are treating residents with dignity and respect, to include an all staff training regarding personal rights. POC to be submitted to CCL by POC due date 8/22/2026.
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Based on interviews conducted, Staff S3 and S5 argued with one another in the presence of residents in care on 8/9/2026, with S5 threatening to kill S3. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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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: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026
LIC9099 (FAS) - (06/04)
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