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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202930
Report Date: 06/23/2026
Date Signed: 06/23/2026 03:38:35 PM

Document Has Been Signed on 06/23/2026 03:38 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:SHIRAN 2 CARE MANAGEMENT INC.FACILITY NUMBER:
435202930
ADMINISTRATOR/
DIRECTOR:		URENA, AIDAFACILITY TYPE:
735
ADDRESS:821 ESCHENBURG DRTELEPHONE:
(408) 649-8537
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 6CENSUS: DATE:
06/23/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Administrator, Aida UrenaTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Simi Rai and Coryse Ngangmenyi conducted an unannounced complaint investigation visit. LPA Rai met with Administrator, Aida Urena and stated the purpose of today's visit. The purpose of the visit is to hand deliver two immediate exclusion letters for two individuals (S1 – S2) who the Department determined engaged in conduct inimical. LPAs also obtained information regarding an Incident Report on 06/04/2026 regarding resident R1's medications were administered at a different time than normal routine.

On 06/11/2026, S1 and S2 had taken two residents each in their own separate vehicles to the beach. On the way back to the facility, S1 was pulled over by local law enforcement and taken into custody for driving under the influence. There were 2 residents inside S1’s vehicle when S1 was pulled over by local law enforcement. Both residents did not sustain any injuries and were transported back to the facility. S2 was aware that S1 was intoxicated prior to driving back to the facility and did not take proactive measures to ensure that S1 did not drive the residents. See LIC809 on 06/16/2026 for additional information.

The immediate exclusion letters were handed to the Administrator (ADM). The ADM was informed to remove S1 and S2 from having any contact with clients and S1 and S2 were not allowed to be physically present in the facility. The ADM was also advised to separate S1 and S2 from the facility roster.

During visit, LPAs handed the immediate exclusion letter to S2.

Continuation on LIC 809-C, Page 1 of 2.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Simranjit Rai
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2026
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 4
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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Document Has Been Signed on 06/23/2026 03:38 PM - It Cannot Be Edited


Created By: Simranjit Rai On 06/23/2026 at 02:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SHIRAN 2 CARE MANAGEMENT INC.
FACILITY NUMBER: 435202930

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/24/2026
Section Cited
HSC
1558(a)(2)

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(a) The department may prohibit any person from being a member of … or allowing contact with clients of a licensed facility..., any employee, prospective employee,...: (2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either the people of this state or an individual in, or receiving services from, the facility or ...
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Administrator stated to submit a Plan of Correction by 06/24/2026 stating how the licensee will ensure that all current and future staff are trained and do not engage in conduct inimical. Administrator agreed and understood.
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Based on interview and record review, the licensee did not comply with the section cited above wherein staff (S1 and S2) engaged in conduct inimical by S1 driving two residents under the influence and S2 knowing S1 was intoxicated when the two residents rode with S1, which poses an immediate health,
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(con't) safety, and personal rights risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Simranjit Rai
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2026


LIC809 (FAS) - (06/04)
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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: SHIRAN 2 CARE MANAGEMENT INC.
FACILITY NUMBER: 435202930
VISIT DATE: 06/23/2026
NARRATIVE
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Page 2 of 2.

On 06/04/2026, the Department received an Incident Report regarding resident R1's medications were administered at a different time than normal routine. LPAs interviewed ADM and S1. LPAs requested copies of resident's Appraisal/Needs and Services, Physician's Report, Centrally Stored Medication Log, Progress Notes and staff training related to medication administration. At this time, this case in under review and Department will conduct a follow up visit , if warranted.

Deficiencies was cited per California Code of Regulations, Title 22, please see LIC809-D. This report was reviewed with Administrator, Aida Urena and a copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Simranjit Rai
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026
LIC809 (FAS) - (06/04)
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