435202785-12-12-2022-26-AS-SYIP-CM6MLM-20221216084233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202785
Report Date: 12/12/2022
Date Signed: 12/12/2022 04:22:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/05/2022 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20220805110110

FACILITY NAME:	AFRA RESIDENTIAL CARE HOME		FACILITY NUMBER:	435202785
ADMINISTRATOR:	ARINES, DIOSDADO EMMANUELS		FACILITY TYPE:	735
ADDRESS:	686 ARDIS AVE		TELEPHONE:	(408) 247-1101
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	6	CENSUS: 5	DATE:	12/12/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Diosdado Arines		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident was sexually abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced complaint visit today to deliver the investigation finding of the allegation that a resident was sexually abused while in care and met with Administrator (ADM) Diosdado Arines.

On 8/5/2022, the Deaprtment recived a complaint with a allegation that a resident was sexually abused while in care.

On the same day, the Department conducted an initial investigation visit and obtained copies of residents’ physician reports, care plan, progress notes, and staff schedule

Continued on 9099-C. Page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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 2

Control Number 26-AS-20220805110110

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: AFRA RESIDENTIAL CARE HOME	FACILITY NUMBER: 435202785
	VISIT DATE: 12/12/2022

NARRATIVE

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Between 08/24/2022 and 11/3/2022, the Department interviewed 3 residents including the alleged victim, the alleged perpetrator, one case worker, a family member, a witness, police detective, and two staff including the administrator.

1 out of 2 residents stated to have no knowledge about the incident, did not know the alleged perpetrator, and was told another person touched the alleged victim in the car. 1 was unable to answer questions. The alleged victim provided varied accounts with different perpetrator’s name depending on the audience.

2 out of 2 staff stated not present at the facility when the alleged incident occurred. Administrator conducted an internal investigation and alleged perpetrator denied touching the resident and left the facility as soon as the next shift caregiver arrived.

The witness denied being told about the incident happened at the facility but did hear about the touching, however, alleged victim did not provide him with detail. The witness also stated the alleged victim never mentioned the name of alleged perpetrator. Per case worker, alleged victim has a wide imagination and would make up stories about his characters but never known to lie about someone in real life.

Police detective was interviewed and stated alleged perpetrator denied touching and staff corroborated the story.

The review of police report noted alleged victim initially denied it happened but later stated alleged perpetrator touched his private part and it lasted for 30 minutes. The alleged perpetrator was noted to again deny touching the alleged victim.

Based on documents reviewed, and interviews conducted, the Department found that the above allegation is 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 cited at today’s visit. Exit interview conducted with ADM. A copy of this report was provided to ADM.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC9099 (FAS) - (06/04)

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