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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202626
Report Date: 04/09/2025
Date Signed: 04/09/2025 04:09:32 PM

Unfounded


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
01/29/2025 and conducted by Evaluator Christine Kabariti
COMPLAINT CONTROL NUMBER: 26-AS-20250129160852
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: 5DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Raul SantosTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Facility staff physically abused a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegation. LPA met with staff, Raul Santos. Administrator, Aaron-Dell Coronel was not feeling well and was unable to meet LPA at the facility.

On 01/29/2025, the Department received a complaint alleging that facility staff (S1) physically abused a resident (R1). On 01/30/2025, the initial complaint investigation was conducted.

The following documents were obtained to include resident (R1)’s physician's report, IPP, emergency form, appraisal/needs and services plan, preplacement appraisal, and police incident card. Page 1 of 2.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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 2
Control Number 26-AS-20250129160852
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: 04/09/2025
NARRATIVE
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It was alleged that on January 11, 2025 R1 was hit by a staff member (S1).

3 staff members were interviewed. Based on staff interviews, it was stated that on January 11, 2025, staff (S2) was assisting R1 in the bathroom when R1 began getting physical with S2. While S2 was assisting R1, R1 defecated on the bathroom floor and asked staff (S1) for assistance. S1 stepped in to assist S2 while R1 was getting physical by swinging his/her hands and hitting the staff. S1 states that during the incident you could hear R1's hands hit the counter and toilet. For R1's safety, S1 was trying to move R1 to the toilet and once he/she sat on the toilet, both staff left the area to allow R1 to calm down. S1 states the situation became really loud because R1 was screaming.

2 out of 2 staff (S1 and S2) who were part of the incident denied physically abusing R1.

Staff conducted a body check, where staff observed R1 sustained a scratch on his/her chin and small bruise on his/her finger from R1 swinging his/her arms. There were no other bruises observed throughout R1's body.

A resident at the facility was interviewed. Based on interview, the resident only heard yelling coming from the bathroom during the incident. Resident denied staff hurting him/her and denied physically seeing staff hurt R1.

Resident (R1) was interviewed, who denied staff physically hurting him/her at the facility.

Staff stated that R1 has many incidents with telling lies. The review of R1’s records corroborates this statement.

The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with staff, Raul Santos and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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