435202934-3-18-2026-26-AS-RMAO-DSGTQC-20260324145544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202934
Report Date: 03/18/2026
Date Signed: 03/18/2026 01:04:33 PM

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
01/16/2026 and conducted by Evaluator Simranjit Rai

COMPLAINT CONTROL NUMBER: 26-AS-20260116125052

FACILITY NAME:	BONITA SPRINGS CARE HOME		FACILITY NUMBER:	435202934
ADMINISTRATOR:	HAROON, SYEDA LUBNA		FACILITY TYPE:	740
ADDRESS:	853 GERONIMO STREET		TELEPHONE:	(408) 841-0248
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	6	CENSUS: 5	DATE:	03/18/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator, Syeda Haroon		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff do not assist residents with medications at night.
Facility staff do not evaluate the condition of the skin exposed to urine and stool to ensure skin breakdown, such as rash, is not occuring.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator, Syeda Haroon and stated the purpose of today’s visit.

On 01/16/2026, the Department received a complaint with the above allegations. On 01/23/2026, the Department conducted an initial investigation at the facility.

Continuation on LIC 9099-C, Page 1 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

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 3

Control Number 26-AS-20260116125052

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: BONITA SPRINGS CARE HOME	FACILITY NUMBER: 435202934
	VISIT DATE: 03/18/2026

NARRATIVE

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Page 2 of 3.
Facility staff do not assist residents with medications at night.

On 01/23/2026, the Department interviewed 3 staff (S1-S2) including Administrator (ADM) Syeda Haroon. ADM stated there are three staff in charge of administering medication: herself and S1 & S2 in the day time and there are two caregivers at night that will administer the medications to the residents. ADM stated there is a resident on Hospice so there is PRN medication available for the Hospice nurse to administer. ADM stated there are no issues she is aware regarding staff not administering medications at night and residents refusing medication at night.

On 01/23/2026, the Department interviewed 4 residents (R1-R4). 1 Out of 4 residents was not available to be interviewed since they were sleeping and 1 Out of 4 residents was not able to provide answers to the questions. 2 Out of 4 residents (R2&R4) stated the staff assist resident with medications and night and both residents stated there have been no issues about medication administration to them or other residents at the facility.

Based on review of 4 residents (R1-R4)’s Medication Administration Records (MARs) for December 2025 - January 2026, LPA Rai reviewed the staff initialed for each day and each dose administered to all residents. The MARs for all four residents were complete, and residents did not refuse any medications or any dose that was not accounted for by staff initials. The MARs documented all medications that were administered to the residents at night, and the staff initialed the dose given to the residents.

On 3/18/2026, the Administrator provided payroll records for LPA to review to show the staff were present during the evening and night to provide medications to the residents. The Administrator stated she will also provide care and supervision during shifts that staff were not available.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20260116125052

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: BONITA SPRINGS CARE HOME	FACILITY NUMBER: 435202934
	VISIT DATE: 03/18/2026

NARRATIVE

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Page 3 of 3.
Facility staff do not evaluate the condition of skin exposed to urine and stool to ensure skin breakdown, such as rash, is not occurring.

On 01/23/2026, the Department interviewed 3 staff (S1-S2) including Administrator (ADM) Syeda Haroon. ADM stated there are 2 residents that need assistance with incontinence care. ADM stated there are no issues with incontinence care with the residents. ADM stated there are no issues with rash occurring on resident’s skin. ADM stated the staff will check the residents every 2-3 hours. ADM stated the facility did not have progress notes on file since there was no change of condition to report on the resident's skin, such as a rash.

On 01/23/2026, the Department interviewed 4 residents (R1-R4). 1 Out of 4 residents was not available to be interviewed since they were sleeping and 1 Out of 4 residents was not able to provide answers to the questions. 2 Out of 4 residents (R2&R4) stated the staff assist with incontinence care and they have no skin issues with rash occurring. R2 stated their skin was itchy but their responsible party brought in cream to put on the skin, but R2 stated they did not have a rash.

Based on review of 4 residents (R1-R4)’s LIC 602A Medical Assessment for Residential Care Facilities for the Elderly, 3 out 4 residents are both bowel and bladder incontinence and require assistance with toileting needs. 1 Out of 4 residents is bowel incontinence and require assistance with toileting needs. 2 Out of 4 residents have a history of skin conditions or breakdown.
Based on review of 5 residents (R1-R5)’s LIC 625 Appraisal/Needs and Services Plan, 4 out 5 residents need assistance with all ADLs. R3 can complete his/her own hygiene tasks but needs assistance with staff providing and preparing the supplies.

The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations 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 and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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