435202784-7-11-2025-26-AS-KHOS-DK2NP2-20250729103736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202784
Report Date: 07/11/2025
Date Signed: 07/11/2025 09:50:53 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
03/28/2025 and conducted by Evaluator Marcela Yanez

COMPLAINT CONTROL NUMBER: 26-AS-20250328171824

FACILITY NAME:	OAKFIELD MANOR LLC		FACILITY NUMBER:	435202784
ADMINISTRATOR:	CASIM, ELVIRA		FACILITY TYPE:	735
ADDRESS:	145 NORTH GADSDEN DRIVE		TELEPHONE:	(408) 945-9197
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	6	CENSUS:	DATE:	07/11/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Elvira Casim		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility has 1 direct care staff supervising 6 residents
Staff is blockiing exits in the facility preventing resident from leaving
Staff not adhering to residents care plan to address elopement behavior.

INVESTIGATION FINDINGS:

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On 07/11/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced visit to deliver the findings of the complaint investigation. LPA stated the purpose of the visit and met with Elvira Casim, Administrator.
On 03/28/25 the department received a complaint for the above allegations.

On 04/03/25 LPA conducted an initial complaint investigation visit and met with Lead Staff Marites Fernandez. LPA reviewed and received copies of 3 resident records including but not limited to, Physicians Report, Individual Program Plan and Appraisal Needs and Services Plan.

During the visit LPA reviewed the facility schedule which shows staff coverage for all shifts and NOC shift. During the visit LPA observed 2 staff for 6 residents. All residents attend day program from 8:00 AM-2:00 pm.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025

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-20250328171824

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: OAKFIELD MANOR LLC	FACILITY NUMBER: 435202784
	VISIT DATE: 07/11/2025

NARRATIVE

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Based on interview, S1 stated he/she did not see any objects or table blocking the entrances or exits during his/her shift. During the visit LPA observed a kitchen table that would need 2 or more individuals to move to block the doorway. LPA observed a recliner and a couch in the common area. The entrance to the facility there is no table near the from door.

During the visit, LPA toured and inspected the facility and observed exits doors are not obstructed by an object or table and are free from debris.

LPA interviewed staff (S1). Based on the interview S1 stated that during his/her shift did not see staff blocking the exit doorway. S1 stated that he/she can only account while he/she is on shift if anyone is blocking the doorway.

LPA observed 5 out of 6 residents who had arrived from Day program. S1 stated that R1, R2, R3 have wandering behavior and requires nearby supervision. R1’s Individual Services Plan states that he/she is not a flight risk and is diagnosed with sensory processing disorder (SPD). R1 gets excited and runs after an ice cream truck, Administrator stated resident no longer has that behavior. R2 IPP and physicians report does not state any wandering behavior. R2 IPP states that he/she can reside in a least restrictive environment but always requires adult supervision while under their care for his/her safety. R1-R4 Appraisal Needs and Services does not state that they need constant supervision. R1-R6 do not require 1 on 1 care.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Elvira Casim, Administrator and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025

LIC9099 (FAS) - (06/04)

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