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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202705
Report Date: 08/11/2025
Date Signed: 08/11/2025 02:28:25 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
06/19/2024 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20240619104312
FACILITY NAME:CRESCENT OAKSFACILITY NUMBER:
435202705
ADMINISTRATOR:JOSHUA LAMBENGCOFACILITY TYPE:
740
ADDRESS:147 CRESCENT AVETELEPHONE:
(408) 730-4004
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:44CENSUS: 39DATE:
08/11/2025
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Joshua LambengcoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff do not ensure incontinence care is provided in a timely manner
Staff do not ensure residents are kept clean and dry
INVESTIGATION FINDINGS:
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On 8/11/2025, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit to deliver the findings. LPA met with Adminstrator Joshua Lambengco and explained the purpose of the visit.

Regarding the allegations of staff do not ensure incontinence care is provided in a timely manner and staff do not ensure residents are kept clean and dry, RP stated that when he/she has gone down to visit R1 on multiple occasions, RP has found R1 in triple diapers and soaked through in his/her linens.

During the interviews, S2 stated that R1 pees a lot so they put double diapers because sometimes R1 takes it off. When R1 takes off the one in the front then there’s another one under. R1 is also hard to get up and bring to the bathroom. It’s easier for them.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
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 6
Control Number 26-AS-20240619104312
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: CRESCENT OAKS
FACILITY NUMBER: 435202705
VISIT DATE: 08/11/2025
NARRATIVE
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They put double diaper with the straps in the front and reversed with the strap in the back. This is to make sure R1 doesn’t take it off because R1 likes to take off his diaper. S3 added that he/she puts 1 brief and pull ups because R1 likes to rip it but nothing else. Never seen R1 with 3 diapers. 1 pull up and 1 brief because R1 rips the brief. Both are padded brief and pull up. The brief has straps. If they put the pull up, R1 pees a lot, it wouldn’t hold everything if it’s just a pull up. S4 shared they just give R1 1 pull up and 1 diaper. S5 said that R2 wears 2 diapers. S6 added that there’s 2 diapers – 2 diapers because R2 would try to pee everywhere. Pull ups and normal.

Based on observation, the regular diapers have straps and the pull ups are banded diapers worn like pull up underwear.

Based on interviews and observation, the above allegations are determined to be SUBSTANTIATED. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties.

Report is reviewed and copy of report and appeals rights is provided.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 26-AS-20240619104312
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: CRESCENT OAKS
FACILITY NUMBER: 435202705
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons.
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Licensee submitted a recent in-servcie training regarding Incontinence Care that was done on August 6, 2025.
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This was not met as evidenced by:
Based on interviews, S2, S3, S4, S5 & S6 mentioned that R1 is put on double diapers due to incontinence issues and R1s behavior of pulling out the diapers which 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.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
06/19/2024 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20240619104312

FACILITY NAME:CRESCENT OAKSFACILITY NUMBER:
435202705
ADMINISTRATOR:JOSHUA LAMBENGCOFACILITY TYPE:
740
ADDRESS:147 CRESCENT AVETELEPHONE:
(408) 730-4004
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:44CENSUS: 39DATE:
08/11/2025
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Joshua LambengcoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff do not ensure resident receives three meals per day
Resident sustained an injury while in care
Licensee does not ensure staff are able to communicate with residents and residents authorized representatives
Staff do not ensure dental hygiene assistance is provided to resident
Facility is not providing resident with shower services based on admission agreement
INVESTIGATION FINDINGS:
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On 8/11/2025, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit to deliver the findings. LPA met with Adminstrator Joshua Lambengco and explained the purpose of the visit.

Regarding the allegation of Staff do not ensure resident receives three meals per day, Responsible party (RP) stated that the staff do not wake the resident (R1) up to go have meals in the dining hall and allowing R1 to skip meals such as breakfast and sometimes lunch multiple days per week.

LPA interviewed six staff members. S1 mentioned that they always give 3 meals per day. All the residents get their meals. They respect their time. They encourage them when they wake up to eat. 20% of them are late risers. If they want to sleep in, they want to sleep in. They will give residents breakfast at a later time. S2 shared that the residents get 3 meals and 2 snacks.
page 1 of 3
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 26-AS-20240619104312
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: CRESCENT OAKS
FACILITY NUMBER: 435202705
VISIT DATE: 08/11/2025
NARRATIVE
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Everybody is provided with meals and snacks, S2 added that they try to convince R1 2-3 times before breakfast but refuses to get up. R1 usually misses snack times because he/she is wandering. S4 said that even if all the residents sleep long they make sure they give breakfast and lunch and added that R1 has never missed breakfast or lunch S4 sees them give his/her food. S5 shared that R1 has skipped meals because R1 is sleeping too late. R1 goes to bed at 9 at night and 1 in the am. When it’s breakfast R1 is asleep. They wake R1 up for breakfast around 9-9:30. S3 and S6 both shared that residents gets 3 meals plus snacks.

Regarding the allegation of resident sustained an injury while in care, RP stated that that R1 has had multiple unwitnessed falls in the common room and staff just sit around on their phones not paying attention. R1 even had a fall and cut his/her head while being changed by 3 staff in his/her room.
During the interviews, S5 shared that they were changing R1 and he/she swung like that towards his/her head and with the edge of the wall stuck, a little blood came out of R1s head. R1 was just standing there and hit his/her head on the wall. There were 4 people because R1 is very aggressive. R1 hits with legs and fist. They need 4 people because they can’t do it.

Based on records review, there were incident reports filed to Licensing about the unwitnessed falls for R1.

For the allegation of Licensee does not ensure staff are able to communicate with residents and residents authorized representatives, RP stated that not all the staff speak nor understand English. The RP stated that he/she will use Google translate on his/her phone to communicate with the staff.

During the interviews, S2 shared that there are staff who are Chinese who will give hand gesture. Staff who doesn’t speak English they’ll call him/her and ask for help. They grab their phone for translation and if they don’t really understand then they’ll call S2. They also have 1 staff who speaks English to help others. S3 mentioned that some of the Spanish speaking staff knows basic words like bathroom, food, breakfast. Or they use the phone, or they ask for help. There is always an English-speaking staff. Always 1 person who speaks English on the floor. S4 stated that they use translation through the phone to communicate. Sometimes if they don’t understand they call for help to someone who speaks English.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 26-AS-20240619104312
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: CRESCENT OAKS
FACILITY NUMBER: 435202705
VISIT DATE: 08/11/2025
NARRATIVE
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Regarding the allegation of staff do not ensure dental hygiene assistance is provided to resident, RP stated that the staff are neglecting R1s dental hygiene by not brushing R1s teeth daily.

According to S2, R1 is being assisted with dental hygiene. 5 days in a week when S2 is on schedule. Hospice helped with toothbrush. S3 shared that, yes to dental hygiene not provided because R1’s refusing. When family member (F1) is here R1 is different but F1 speaks the language R1’s talking. F1 tries to give R1 the brush but he/she just sees it and puts it down. S3 tries to help him but he/she smacks his/her hands. Even with shaving. If R1 doesn’t want it then S3 leaves R1 alone and can’t force him/her. S3 will try it again but R1 doesn’t want to. S3 tries 3-4 times before. Normally S3 tells to the medtech when R1 refuses. S4 adds that with R1, they brush his/her teeth in the shower room because it’s hard to do it in the bathroom sink. S5 shared that it’s impossible to brush R1s teeth. R1 doesn’t like it. R1 will kick and spit out the cream. S6 mentioned that R1 would put the caregivers fingers when they try to brush his/her teeth. R1 is aggressive. At first, yes S6 helps R1 but he/she doesn’t want them to help him/her.

Regarding the allegation that Facility is not providing resident with shower services based on admission agreement, RP stated that the facility staff doesn't shower R1. R1 should be getting 2 additional showers from the facility per the agreement. On Thursdays hospice comes to also assist with showers. Other than that from what RP sees Thursday and Friday R1s hair is not greasy because Hospice comes on Thursdays for showers. They are supposed to give R1 2 additional showers per week but only Hospice is showering R1.

According to interviews, S1 shared that Hospice provides 2 showers per week and staff assist the hospice. They always assist hospice because with his behavior he is very hard and unpredictable. S3 stated that showers right now, it’s him/her and hospice. R1 gets aggresive with showers. Hospice is giving R1 showers. Their shower schedule is Tuesday and Thursday for hospice. They’re not giving him showers because R1s shower schedule is the same day as hospice schedule. They only shower him when R1 soiled himself/herself, then they help with showers. Hospice is doing the shower.

Based on records review, for the month of June 2024, there were shower logs at least twice a week. Some of the days on record are not under the hospice schedule which are Tuesday and Thursday.

Report is reviewed and copy is provided.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6