435202670-5-7-2025-26-AS-KHOS-DGMLD2-20250513083913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202670
Report Date: 05/07/2025
Date Signed: 05/07/2025 10:01:54 AM

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
04/22/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250422114517

FACILITY NAME:	SILICON VALLEY SENIOR CARE HOME		FACILITY NUMBER:	435202670
ADMINISTRATOR:	LADWIG, JUVELYN IRISH		FACILITY TYPE:	740
ADDRESS:	5255 RAFTON DR		TELEPHONE:	(408) 677-4405
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY:	6	CENSUS: 6	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lead Staff Joey Cervantes		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not address residents behavior of yelling, resulting in disturbing sleeping residents.
Residents are smoking inside the facility

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Manuel Monter and Marcella Tarin conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Lead Staff Joey Cervantes.

On April 22, 2025, the Department received a complaint alleging Facility did not address residents behavior of yelling, resulting in disturbing sleeping residents.

On April 23-30, 2025, LPA Monter interviewed residents R1-R6. (During interviews with residents, LPA spoke at a normal base line sound level, and did not need to raise his voice for residents to hear questions posed by LPA.) Resident R1 declined to be interviewed.

Page 1 Out of 3.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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 3

Control Number 26-AS-20250422114517

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: SILICON VALLEY SENIOR CARE HOME	FACILITY NUMBER: 435202670
	VISIT DATE: 05/07/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Resident R2 stated R1 has been screaming. R2 stated R1 will Storm up and down the hallways. R2 stated R1’s screaming became unnerving and happens many times at night. LPA asked R2 how loud R1 is and if he/she can describe the noise. R2 stated R1 mostly yells in his/her room. R2 described the sound like an animal that can be heard pretty much through the entire home. R2 stated when R1 yells, The staff will go to talk to R1 to calm him/her down.

3 Out of 6 residents (R3, R4, R6) interviewed stated they haven’t heard screaming or yelling at the facility day or night. R5 stated around the time when R1 first moved in, there was a day when R1 was talking really loudly. R5 stated R1 wasn’t screaming or screeching. R5 stated the loud talking only occurred 1 time. R5 stated he/she hasn't heard yelling/screaming or screeching and has had no issues.

LPA interviewed staff S1 and S2. S1 and S2 stated when R1 first moved in, he/she was agitated and talk in a loud voice. S1 and S2 stated R1 did not scream/yell. S1 and S2 stated they responded to R1 speaking loudly. Staff S1 and S2 stated they spoke to R1 and redirected R1 to help R1 calm down. Both staff interviewed stated R1 has calm down and not had any incidents since then.

LPA interview ADM Ladwig. ADM stated R1 has had 2 incidents where R1 was speaking loudly. ADM stated R1 was not screaming or yelling. ADM stated on March 31st, 2025, R1 was talking loudly. ADM stated staff attempted to redirect R1. ADM stated they would ask R1 what he/she wants and ask what the problem is. ADM stated that day R1 was not cooperating and complaining about a potential doctor visit the following day. ADM stated staff attempted to redirect R1, but R1 continued to talk loudly in his/her room. ADM stated R1 was taken to a local hospital, to be re-assessed because R1 was having trouble sleeping. ADM stated R1 was prescribed a new medication.

ADM stated regarding the outburst on April 22, 2025, one of her residents had complained about R1 yelling. ADM stated this occurred on April 22, 2025, 5:24am. ADM stated R1 doesn’t yell. ADM stated R1 is talking loud to him/herself. ADM stated that she was informed that it bothers some of the residents. ADM stated R1 isn’t yelling. R1 is just talking loud. ADM stated when R1 was talking loudly, staff will try to redirect R1. ADM stated they reported this changes to R1’s physician and the behaviors has been fine since they have updated R1’s medications.
Page 2 Out of 3.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250422114517

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: SILICON VALLEY SENIOR CARE HOME	FACILITY NUMBER: 435202670
	VISIT DATE: 05/07/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Residents are smoking inside the facility

On April 22, 2025, the Department received a complaint alleging residents are smoking inside the facility.

On April 23-30, 2025, LPA Monter interviewed residents R1-R6. Resident R1 declined to be interviewed. R2 stated he/she is not sure where R1 is smoking. R2 stated R1 might be smoking in his/room or in the outside deck but cannot be 100% sure. 4 Out of 6 residents (R3-R6) interviewed stated they have never seen residents smoking inside the facility.

LPA interviewed staff S1 and S2. Both staff interviewed stated only resident R1 smokes. S1 and S2 stated R1 smokes outside in the smoking area. Both staff interviewed stated they have never seen R1 smoking inside the facility.

LPA interview ADM Ladwig. ADM stated the only resident who smokes in the facility is resident R1. ADM stated there is an area where R1 can smoke. ADM stated R1 knows to smoke there. ADM stated R1 does not smoke inside the facility. ADM stated she has never seen or heard about R1 smoking inside the facility.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

This report was reviewed with Administrator Ladwig via phone call. ADM stated Lead Staff Joey Cervantes can sign on her behalf. A copy of the signed report was provided.

Page 3 Out of 3. END OF REPORT.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 388-2297
LICENSING EVALUATOR NAME: Manuel Monter	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3