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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202770
Report Date: 12/03/2024
Date Signed: 12/03/2024 12:27:00 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
03/23/2023 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20230323155847
FACILITY NAME:A AND A RESIDENTIAL CARE HOME, INC.FACILITY NUMBER:
435202770
ADMINISTRATOR:FARAKESH, REZAFACILITY TYPE:
735
ADDRESS:1084 WALLACE DRTELEPHONE:
(415) 385-8900
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:6CENSUS: 4DATE:
12/03/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Staff - Fredricka SafarTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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- Facility is exposing resident to verbal arguments.
INVESTIGATION FINDINGS:
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On 12/03/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver findings regarding the allegation received. LPA met with Fredricka Safar and explained te purpose of today's visit.

During the investigation inteviews were conducted, observations are made, and documentation is reviewed. Per the interviews conducted, client interviewed do not recall any arguments being witnessed or heard. Some clients indicated that some of the other clients have beviors that may be considered as arguments if heard from persons not familiar with facility or the clients. Staff inreviewed do not have first have witnessed accounts of arguments taking place in view of the clients as the staff based this off of hearsay from other staff. LPA cannot prove or disprove the allegation took place. This allegation is unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

LPA reviewed this report with Fredricka Safar and provided a copy of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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