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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202719
Report Date: 07/17/2025
Date Signed: 07/17/2025 04:04:36 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
04/24/2025 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20250424164126
FACILITY NAME:EBADAT RESIDENTIAL CARE HOME #2FACILITY NUMBER:
435202719
ADMINISTRATOR:SHU JEN COLLADOFACILITY TYPE:
735
ADDRESS:5686 TONOPAH DRTELEPHONE:
(408) 224-8258
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:6CENSUS: 6DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator, Shu Jen ColladoTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility staff verbally abusing resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator and stated the purpose of today’s visit.

On 4/24/2025, the Department received a complaint with the above allegations. On 5/2/2025, the Department conducted an initial investigation at the facility.

It was alleged that the staff were calling residents “stupid”, “was too much” and/or saying no one cared about them.

Continuation on LIC 9099-C, Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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 4
Control Number 26-AS-20250424164126
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 #2
FACILITY NUMBER: 435202719
VISIT DATE: 07/17/2025
NARRATIVE
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Page 2 of 2.

On 5/2/2025, the Department interviewed Administrator (ADM) Shu Jen Collado. ADM stated she has not heard or seen staff verbally abusing residents or saying the alleged words to the residents. ADM stated the staff are trained and have signed SOC341 regarding Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders.

During today’s visit, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated they have not verbally abused resident or used those specific phrases to the residents. Two out of two staff stated they have not seen or heard any other staff saying that to the residents. S1 stated that he/she has heard residents say that to the staff when they are angry or upset.

During today’s visit, LPA Rai interviewed 4 residents (R1-R4). One resident (R2) refused to be interviewed. Three out of three residents stated they have not seen or heard staff verbally abusing residents. Three out of three residents stated they have not heard the staff use those specific phrases to the residents.

LPA Rai reviewed records at random of 5 staff files and 5 out of 5 staff files contained signed SOC341 Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4