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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202779
Report Date: 10/23/2025
Date Signed: 10/23/2025 05:25:27 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
08/04/2025 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20250804131913
FACILITY NAME:REAL ELDERLY CAREFACILITY NUMBER:
435202779
ADMINISTRATOR:ARIES GERONIMOFACILITY TYPE:
740
ADDRESS:4858 POSTON DRIVETELEPHONE:
(408) 440-2441
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:6CENSUS: 4DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Jocelyn RealTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Resident sustained an unexplained fracture due to staff neglect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Jocelyn Real, Licensee. On 08/04/2025, the department received a complaint with the above allegation. On 08/05/2025, LPA Marrufo conducted an initial complaint investigation visit.

Resident R1 is non-ambulatory, does not attend a day program, and requires complete assistance with all activities of daily living (ADLs). R1 requires two-person assist when transferring between wheelchair and bed and has a history of minor bruising on his/her arms due to his/her fragile skin and arthritis. On 07/19/2025, at approximately 0900 hours, a small purple bruise was found on R1’s right upper arm and reported to all staff via a group chat. It was not until 07/22/2025 that staff contacted R1’s home health nurse to report R1’s bruise. R1’s home health nurse advised staff to address the bruise at R1’s existing appointment on 07/24/2025 and to apply a cold compress for the time being. See LIC9099-C page for more information. Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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-20250804131913
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: REAL ELDERLY CARE
FACILITY NUMBER: 435202779
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of
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Licensee agrees to submit a plan of correction by Plan of Correction Due Date of 10/24/2025 stating how the licensee plans on conducting in-service training with staff on ensuring that the personal rights of residents are upheld, including the right to care, supervision,
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the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

This requirement was not met as evidenced by: Licensee did not ensure that staff provided care, supervision, and services that meet the individual needs of resident R1 and that staff were sufficient in numbers, qualifications, and competency to meet R1’s needs to prevent R1 from sustaining an unexplained fracture, which poses an immediate health and safety risk to residents in care. *An immediate civil penalty of $500 is being assessed today.*
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and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Once training is completed, Licensee shall submit copies of training records, including names of staff trained, dates of training, training topics, and names and qualifications of trainers to the department.
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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: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20250804131913
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: REAL ELDERLY CARE
FACILITY NUMBER: 435202779
VISIT DATE: 10/23/2025
NARRATIVE
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Staff were instructed not to provide care to R1 alone and that two staff were required to assist R1 with all his/her ADLs.

On 07/24/2025, R1’s Primary Care Physician (PCP) examined R1 and noted a resolving ecchymosis/edema on R1’s right upper arm. An X-ray was ordered and showed a displaced comminuted proximal right humeral fracture. R1 was treated with an arm sling. During interview, R1’s PCP stated displaced “comminuted” or fragmented bone injuries typically occur due to impact trauma, such as a car crash or a fall “of considerable height” from a “bed or during a shower.” Such injuries are not generally caused by mishandling or pulling of the arm.

Staff interviewed said that an unwitnessed fall would have been unlikely given R1 was immobile and the right side of R1’s bed was against the wall. Staff did not know how R1 sustained a shoulder fracture. Interviewed staff stated that there was no change to R1’s behavior or baseline in the days prior to when the bruise was discovered. Interviewed staff stated R1 always cried when he/she moved, changed, or was in pain due to the contractures of his/her arms and legs.

Based on records review and interviews, there is preponderance of evidence to prove the alleged violation did occur; therefore, the allegation is substantiated.

An immediate civil penalty of $500 is being assessed today for serious bodily injury or death. See LIC421IM for more information.

See 9099-D for deficiencies cited per the California Code of Regulations, Title 22.

Failure to correct the deficiency may result in a civil penalty. At the time of the inspection report on 10/23/2025, Licensee was informed that the incident is under review and future civil penalties may apply based on Health and Safety Code 1569.49.

This report was reviewed with Licensee Jocelyn Real and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORT.
SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3