435202906-10-2-2025-26-AS-RMAO-DMEQU4-20251013122807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202906
Report Date: 10/02/2025
Date Signed: 10/02/2025 10:53:46 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
03/17/2025 and conducted by Evaluator Christine Kabariti

COMPLAINT CONTROL NUMBER: 26-AS-20250317141342

FACILITY NAME:	SPENCER ADULT CARE HOME		FACILITY NUMBER:	435202906
ADMINISTRATOR:	TEODORO, ANELISE		FACILITY TYPE:	735
ADDRESS:	9055 SPENCER CT		TELEPHONE:	(408) 393-8075
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	6	CENSUS: 6	DATE:	10/02/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Anelise Teodoro		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Client sustained unexplained injuries while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding of the above allegation. LPA met with Administrator, Anelise Teodoro.

On 03/17/2025, the Department received a complaint alleging that resident (R1) sustained unexplained injuries while in care.

Based on the reporting party (RP), on 03/14/2025 R1 went to visit family when the family member noticed that R1 had a skin tear on his/her cheek and cuts on his/her fingers. The RP spoke with the facility staff who had documented the abrasion on the cheek. The cuts on R1’s fingers were not documented. RP stated to have observed the cuts and bruise through photos and described the cuts to look like paper cuts. RP also states that R1’s family member stated that R1 had bruises on each arm a week ago, which the facility did not have documentation of the arm bruises. The RP states that R1’s responsible party is not alleging physical abuse but wants the facility to provide more supervision. Page 1 of 4.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

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 4

Control Number 26-AS-20250317141342

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: SPENCER ADULT CARE HOME	FACILITY NUMBER: 435202906
	VISIT DATE: 10/02/2025

NARRATIVE

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On 03/27/2025, the initial complaint investigation was conducted. Documents were obtained to include email correspondence, resident (R1)’s physician’s report, IPP, appraisal/needs and services plan, body check records for March, progress notes, and staff schedule.

On 03/27/2025, 2 staff members were interviewed. Based on interview, the Administrator and S2 states they do body check records every day in the morning and afternoon when the residents come back from school. It was stated that body checks are typically done during daily showers.

The review of facility records shows that on 03/08/2025, the facility noted in their progress notes that R1 returned from school with a bruise on his left and right arm. Based on the body check log the bruise on the left and right arm was first noted on 03/09/2025.

On 03/11/2025, the facility staff noted that R1 accidentally scratched his face. The body check log indicates the scratch on R1’s face in the AM and PM. Staff did not note the bruise from days prior. Staff also did not note any scratches to R1’s fingers and hands.

5 staff members were interviewed. Based on staff interview, the Administrator stated the scratch on R1’s face was reported by staff (S4) who informed the Administrator that R1 scratched his/her face after giving R1 a shower. S4 was interviewed who stated that the scratch on R1's face was because R1 has tendencies to put his hands on his face and ears and scratches it. 5 staff interviewed did not know how R1 sustained the scratches on his/her hands. The Administrator stated that around the time of the incident, R1 was also attending school.

3 out of 5 staff interviewed did not know how R1 sustained the bruise on his/her arms. 1 of the staff (S4) thinks that another resident (R2) was agitated and grabbed R1’s arms, and thinks that is how R1 sustained the bruises on his/her arms. S4 stated to have made a personal note about it in March but did not note the exact date and time.
Page 2 of 4.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20250317141342

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: SPENCER ADULT CARE HOME	FACILITY NUMBER: 435202906
	VISIT DATE: 10/02/2025

NARRATIVE

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The second staff, S1 remembers that sometime in March 2025, S1 received a call from R1's teacher who reported that R1 accidentally fell off the bleachers at school during P.E. The school checked R1 and did not find any bruises at the time incident, but knows bruises show up after a few days.

The review of records shows that on 03/14/2025, the Department received an incident report for R1. There was no prior incident reports regarding the observation of bruises. The incident report stated that the Administrator had reminded staff to conduct daily body checks of all individuals including R1 before they were picked up from school. Staff informed the Administrator that the only note on R1’s body check was the minor scratch on R1’s face when he/she had accidentally scratched it when staff was attempting to cut his/her fingernails. R1’s responsible party and school was informed on 03/11/2025 regarding the minor scratch. R1’s responsible party mentioned to the Administrator of challenges R1 has when getting his/her fingernails cut and reinforcements that has helped.

On the same day, 03/14/2025, the facility was informed of wounds on R1’s hand during pick-up with R1’s responsible party. The Administrator followed-up with the staff who stated they had conducted a body check on R1 that morning, and there was no wound on his/her hand that was found.

A follow-up meeting with R1’s support team was scheduled for 03/17/2025.

On 03/17/2025, an email correspondence was sent regarding a recap of the meeting. Based on the correspondence, it’s encouraged for the Administrator to continue to communicate with R1’s responsible party for any changes to R1, for R1’s responsible party to complete a body scan of R1 before home visits, and encourage the Administrator and R1’s responsible party to connect with the school as he/she could also sustain an injury during school hours.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20250317141342

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: SPENCER ADULT CARE HOME	FACILITY NUMBER: 435202906
	VISIT DATE: 10/02/2025

NARRATIVE

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Based on the staff schedule, from Monday - Friday there is about 3 staff scheduled from 6AM – 9AM, 5 staff from 3PM – 9PM, 3 staff from 9PM – 10PM, and 1 staff from 10PM – 6AM. On the weekends (Saturday and Sunday) there is 3 staff from 6AM – 10PM and 1 staff from 11PM – 6AM. The facility census around March 2025 was 6 residents. The Administrator denied any concerns with their staffing numbers.

The Department has investigated the above allegation. Based on interviews, records reviewed and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Anelise Teodoro and a copy of the report was provided.

Page 4 of 4.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4