435202961-8-25-2025-26-AS-RMAO-DLASAU-20250907134251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202961
Report Date: 08/25/2025
Date Signed: 08/25/2025 01:21:28 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
05/28/2025 and conducted by Evaluator Simranjit Rai

COMPLAINT CONTROL NUMBER: 26-AS-20250528123624

FACILITY NAME:	ELLORE SENIOR LIVING		FACILITY NUMBER:	435202961
ADMINISTRATOR:	AQUINO, JOYCE		FACILITY TYPE:	740
ADDRESS:	2350 CALLE DE LUNA		TELEPHONE:	(408) 755-6868
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95054
CAPACITY:	303	CENSUS: 27	DATE:	08/25/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Director, Slyvia Chu		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are performing tasks outside of their defined scope of duties without designated reliever for coverage resulting in residents not being provided care and supervision.
There has been lack of response by Administrator concerning staffing and resident assignments resulting in residents at risk for unusual incidents and/or delay of services.

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 Executive Director, Slyvia Chu and stated the purpose of today’s visit.

On 5/28/2025, the Department received a complaint with the above allegations. On 5/30/2025, the Department conducted an initial investigation at the facility. On 6/23/2025, the Department conducted an additional 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: 08/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025

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 3

Control Number 26-AS-20250528123624

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: ELLORE SENIOR LIVING	FACILITY NUMBER: 435202961
	VISIT DATE: 08/25/2025

NARRATIVE

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Page 2 of 3.

Staff are performing tasks outside of their defined scope of duties without designated reliever for coverage resulting in residents not being provided care and supervision.
It was alleged that the care staff are covering the breaks for the front desk staff.

On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated there is 1 staff to 3 residents and the staff have ample time to do their work without issues. Two out of two staff stated the extra staff for the day will help with covering break time for the front desk staff. S2 stated the extra staff (or the third staff on the floor) will be tasked to give front desk their break. The staff will cover the front desk for 10 minutes and are trained to answer phone calls and responding to certain emergencies.

On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated the staffing ratio has been 1 resident to 1 staff or at most, 2 residents to 1 staff. S3 stated they have extra staff on the floor to ensure there is enough coverage of when the facility accepts additional residents. S3 stated the extra caregiver will assist with covering front desk personnel’s 10 minute break.

On 6/23/2025, LPA Rai attempted to interview 2 residents (R1-R2), however 2 out of 2 residents refused to speak or answer LPA Rai’s questions regarding the allegation.

There has been a lack of response by Administrator concerning staffing and resident assignments resulting in residents at risk for unusual incidents and/or delay of services.

On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated the Administrator and Human Resources (HR) have responded to concerns related to resident’s care assignments. S2 stated if there are call-off for the shifts, S2 will help cover the shift. S2 has not seen or heard issues which result in residents at risk to their safety and/or delay of receiving care services.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250528123624

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: ELLORE SENIOR LIVING	FACILITY NUMBER: 435202961
	VISIT DATE: 08/25/2025

NARRATIVE

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Page 3 of 3.

On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated the staffing ratio has been 1 resident to 1 staff or at most, 2 residents to 1 staff. S3 stated they have extra staff on the floor to ensure there is enough coverage of when the facility accepts additional residents. S3 stated he/she cannot speak on the behalf of previous Administrator, but S3 has not seen or heard any safety concerns related to staffing and resident assignments which may have resulted in residents at risk or incidents and/or delay of care services.

On 6/23/2025, LPA Rai attempted to interview 2 residents (R1-R2), however 2 out of 2 residents refused to speak or answer LPA Rai’s questions regarding the allegation.

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 Executive Director, Slyvia Chu and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3