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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202788
Report Date: 06/25/2026
Date Signed: 06/25/2026 11:45:18 AM

Unfounded


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
06/16/2026 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20260616161940
FACILITY NAME:DELIA'S RESIDENTIAL COMMUNITY 2FACILITY NUMBER:
435202788
ADMINISTRATOR:BUNO, CARMENFACILITY TYPE:
740
ADDRESS:167 BLAKE AVETELEPHONE:
(408) 799-6239
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:6CENSUS: 6DATE:
06/25/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Administrator, Dina DomingoTIME COMPLETED:
09:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not address resident diabetic care being provided at the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Simi Rai conducted an unannounced complaint investigation visit. LPA Rai met with Administrator (ADM) Dina Domingo and stated the purpose of today's visit.

During visit, LPA Rai interviewed 1 staff (S1) and Administrator (ADM). Both staff stated resident (R1) does not reside at this location but is a resident at another location owned by the Licensee. LPA Rai confirmed R1 does not reside at this facility, but at another licensed facility.

The Department has completed the investigation of the above allegation. Based on interviews conducted and record reviews, the department has found that the above allegation were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator, Dina Domingo and a copy of the report was provided
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026
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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