435202913-2-23-2026-26-AS-MPAA-DRKSZ2-20260223131825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202913
Report Date: 02/20/2026
Date Signed: 02/23/2026 01:19:07 PM

Document Has Been Signed on 02/23/2026 01:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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:	FARA RESIDENTIAL CARE HOME		FACILITY NUMBER:	435202913
ADMINISTRATOR/ DIRECTOR:	PONGYAN, JOELITO		FACILITY TYPE:	735
ADDRESS:	5821 INDIAN AVENUE		TELEPHONE:	(408) 655-1226
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY: 6		CENSUS: 5	DATE:	02/20/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Joelito Pongyan		TIME VISIT/ INSPECTION COMPLETED:	10:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced case management – incident visit to deliver the findings of the alleged sexual abuse of a resident while in care. LPA was greeted by 3 staff, and 2 residents. Administrator (ADM) Joelito Pongyan was not present at the time of LPAs arrival. Staff called ADM and stated that ADM is on his/her way to the facility. The facility serves 18 to 59 years who are developmentally disabled. On 09/03/2025, the Department received and incident report stating that resident 1 (R1) was sexually assaulted by a staff 1 (S1). The Department investigated the incident, and the narrative is as follows: The incident occurred on 09/01/2025, wherein R1 was consistent with his/her account of the incident to various parties when interviewed. Based on the initial interview R1 consented to S1 kissing him/her on the cheek and lips but did not consent to S1s intimate kissing nor touching private parts. R1 made the statement to his/her responsible party (RP), law enforcement (LE) and facility staff (S2) that were inconsistent. R1 stated that S1 asked R1 to sit on S1s lap and described S1's physically description but did not name S1. According to RP, R1 never described S1 physically attributes. R1 always refer to the S1 as the “new” staff. R1 stated to LE, that he/she consented to S1 touching his/her private part but did not consent to kissing his/her private part. see LIC809C page 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: FARA RESIDENTIAL CARE HOME	FACILITY NUMBER: 435202913
	VISIT DATE: 02/20/2026

NARRATIVE

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Based on review of R1s medical record, R1 is diagnosed with psychotic disorder with delusions and a history of traumatic or stressful life experience.

Based on interview, RP stated that R1 has Prader-Willi Syndrome, and R1 has a history of confabulation, wherein R1 believes imaginary things happened to him/her personally. When R1 confabulates, it is innocent in nature and details change whenever R1 talks about the incident. RP stated that R1 has not made any sexual abuse allegations before.

Based on staff interviews, S1 was left with R1 who was watching TV and R2 who at that time were sleeping in the living room. Staff 2 (S2) left the facility for approximately 1 hour to refill a jug of water and when S2 came back, S1, R1 and R2 were seated in the same spots where S2 left them. R3 is non-verbal and R4 did not witness the incident and stated that S1 is a good employee. S2 stated that he/she talked to S1 and S1 denied the allegations that he/she had an inappropriate behavior with R1. The Department was unable to interview S1. S1's employment has been terminated. Attempts to contact S1 were unsuccessful. Licensee stated that S1 left the country and that S1 wrote to Licensee denying the allegations and stating that R1 was “too focused on the show” and were uttering things that S1 did not understand, S1 further stated on the letter to Licensee, that S1 asked R1 “what’s the matter with you?” in which R1 responded pertaining to the opposite gender. S1 stated that he/she approached R1 and put his/her hand on the back shoulder of R1 and told R1 not to worry. S1 stated on his/her letter to licensee that R1 went to his/her room after the show ended.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiency is cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with ADM Joelito Pongyan and a copy of the report was provided.

end of report
page 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC809 (FAS) - (06/04)

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