435202671-10-10-2025-26-AS-CKAI-DQS33J-20260128165337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202671
Report Date: 10/10/2025
Date Signed: 10/10/2025 04:44:46 PM

Unsubstantiated

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
07/02/2025 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20250702091704

FACILITY NAME:	EDRICBOYLYNN RESIDENTIAL CARE HOME INC		FACILITY NUMBER:	435202671
ADMINISTRATOR:	REMEDIOS SINGSON		FACILITY TYPE:	735
ADDRESS:	1307 PARK PLEASANT CIR		TELEPHONE:	(408) 929-4958
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	6	CENSUS: 5	DATE:	10/10/2025
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Linda Arciaga		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility staff did not treat resident with dignity and respect
Staff are not responding timely to assist resident with bowel and/or bladder needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Linda Arciaga, Administrator (ADM). On 07/02/2025, the department received a complaint with the above allegations. On 07/11/2025, LPA Marrufo conducted an initial complaint investigation visit.

On 07/11/2025, LPA Marrufo obtained resident R1’s Physician’s Report and Appraisal/Needs and Services Plan.

R1’s Physician’s Report is dated 10/09/2024. R1’s Physician’s Report states R1 does not have bowel impairment, bladder impairment, or motor impairment.

See LIC9099-C pages for more information. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

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-20250702091704

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: EDRICBOYLYNN RESIDENTIAL CARE HOME INC	FACILITY NUMBER: 435202671
	VISIT DATE: 10/10/2025

NARRATIVE

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R1’s Physician’s Report states R1 cannot care for all his/her personal needs, is not able to bathe himself/herself and requires full assistance for bathing, is not able to dress himself/herself, and cannot care for his/her own toileting needs, including not being able to clean himself/herself after using the toilet. R1’s Physician’s Report states R1 can independently transfer to and from bed and is ambulatory.

R1’s Appraisal/Needs and Services Plan was completed on 08/07/2024. The Background Information of R1’s Appraisal/Needs and Services Plan states, “[R1] requires complete physical assistance, verbal prompting and reminders to manage [his/her] personal care which includes hygiene. [R1] can only do some of [his/her] ADLs [Activities of Daily Living] like brushing [his/her] teeth and eating.” The Functioning Skills of R1’s Appraisal/Needs and Services Plan states, “[R1] needs complete physical assistance to perform some of [his/her] ADLs.” The persons responsible for implementing R1’s functional skills needs is listed as “All Staff.”

Facility staff did not treat resident with dignity and respect

During interview on 07/11/2025, R1 stated that a male staff, whose name R1 does not know, showed R1 his middle finger, spit on R1’s leg and on the floor in front of R1, pulled his pants down and showed his buttocks at R1, and flicked his tongue at R1. R1 stated that the male staff committed these disrespectful gestures to R1 on the same day. R1 stated the incident involving the male staff committing the disrespectful gestures to R1 may have occurred about a month prior to the interview. R1 stated the staff still works at the facility but is no longer allowed to work with R1.

During visit on 07/11/2025, LPA Marrufo interviewed staff S2-S7. S2-S7 stated that they have not personally nor have they observed any other staff do any of the following to R1: show R1 his/her middle finger, spit on R1’s leg and on the floor in front of R1, pull his/her pants down and shown his/her buttocks at R1, flicked his/her tongue at R1, or use disrespectful gestures towards R1.

During visit on 10/10/2025, LPA Marrufo interviewed ADM, who stated staff have never shown R1 his/her middle finger, spit on R1’s leg and on the floor in front of R1, pull his/her pants down and shown his/her buttocks at R1, flicked his/her tongue at R1, or use disrespectful gestures towards R1. ADM stated to have never had a staff with the name that R1 provided. Page 2 of 3.

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250702091704

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: EDRICBOYLYNN RESIDENTIAL CARE HOME INC	FACILITY NUMBER: 435202671
	VISIT DATE: 10/10/2025

NARRATIVE

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Staff are not responding timely to assist resident with bowel and/or bladder needs

During interview on 07/11/2025, R1 stated that about nine months prior to the interview, when R1 first moved into the facility, staff S1 took R1 to the bathroom and made R1 wait two hours before assisting R1 with wiping after using the toilet. R1 provided LPA Marrufo the name of S1, but R1 stated to not be sure if that was actually the name of S1. R1 stated S1 was not present at the facility during the day LPA Marrufo visited the facility.

On 10/06/2025, LPA Marrufo obtained a copy of the Guardian Employee Roster. LPA Marrufo did not find any staff associated to the facility with either the first name or last name of the staff that R1 provided to LPA Marrufo during interview on 07/11/2025.

During visit on 07/11/2025, S2-S7 stated that staff take R1 to the bathroom as soon as R1 requests to be taken to the bathroom. S2-S7 stated to have never left R1 on the toilet for two hours and have never observed any other staff doing so.

During interview on 10/10/2025, ADM stated staff assist R1 immediately when R1 rings the bell that ADM placed near R1's bed. ADM stated staff have never left R1 on the toilet for more than two hours. ADM stated staff help R1 immediately on the toilet.

Based on information from interviews conducted with staff and resident, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22

This report was reviewed with Administrator Linda Arciaga and a copy of this report was provided.

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END REPORT

SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3