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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202770
Report Date: 08/11/2025
Date Signed: 08/11/2025 11:52:14 AM

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
04/25/2025 and conducted by Evaluator Grace Donato
COMPLAINT CONTROL NUMBER: 26-AS-20250425165443
FACILITY NAME:A AND A RESIDENTIAL CARE HOME, INC.FACILITY NUMBER:
435202770
ADMINISTRATOR:BARBA, JOSE ROBERTOFACILITY TYPE:
735
ADDRESS:1084 WALLACE DRTELEPHONE:
(415) 385-8900
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:6CENSUS: 6DATE:
08/11/2025
UNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:Tess De AusenTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff verbally abuse clients
Staff physically abuse clients
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 on the complaint received by the department on 04/29/2025. LPA met with Tess De Ausen and explained the purpose of the visit.

On 04/29/2025, the Department conducted an initial complaint investigation, interviewed 3 staff, administrator (ADM)/Licensee and requested copies of physician's report (LIC602) and individual program plan (IPP). The facility serves 6 non-ambulatory adults ages 18-59 with developmental disability.

Regarding the allegations that Staff verbally and physically abused clients, Reporting Party (RP) stated that he/she lives in the same neighborhood as the facility and has witnessed staff (S2 & S5) hit residents R1 & R2.

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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)
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Control Number 26-AS-20250425165443
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: A AND A RESIDENTIAL CARE HOME, INC.
FACILITY NUMBER: 435202770
VISIT DATE: 08/11/2025
NARRATIVE
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During the interviews, 5 out of 5 staff stated they have not observed a staff verbally or physically abuse a resident in care. LPA attempted to interview 4 residents, and 1 resident declined to be interviewed. ADM stated that residents undergo a full body check when residents arrive from the day program or outings. S2 stated that R1 can be difficult. R1 bites his/her hand and hits his/her hand on things and shouts when he/she has behaviors. Giving R1 cookies help him/her to return to baseline. Residents get physical sometimes but S2 never hit or kicked any of the residents. S5 also shared that they are the one being hit by the residents but they can only do de-escalation but not hit or shout at them. LPA attempted to interview the responsible parties for the residents but was not able to get hold of them.

Based on observations, when LPA Donato visited that facility, both R1 and R2 where in the living room as the classes don’t start till the following week. Both residents were calm and approached S2 and S5 when they need anything. There were no signs of physical or verbal abuse.

Based on records review, a visit from police on 4/29/2025 mentioned that there was no evidence of physical abuse to the residents.

Based on interviews, records review and observations, the department has determined that 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 allegations are UNSUBSTANTIATED.



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)
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