435294224-6-16-2025-26-AS-MPAA-DHXLVL-20250624090540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294224
Report Date: 06/16/2025
Date Signed: 06/16/2025 04:01:15 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
06/09/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20250609090532

FACILITY NAME:	CAMPBELL VILLAGE		FACILITY NUMBER:	435294224
ADMINISTRATOR:	DE OCAMPO, GERALYN		FACILITY TYPE:	740
ADDRESS:	290 N. SAN TOMAS AQUINO ROAD		TELEPHONE:	(408) 378-2535
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	90	CENSUS: 63	DATE:	06/16/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Admininstrator Geralyn De Ocampo		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff require the residents to shower together while in care
Staff are mistreating the residents while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced initial complaint investigation visit and met with Administrator (ADM) Geralyn De Ocampo

On 6/9/2025 the Department received a complaint with the above allegations

During visit LPA Tarin interviewed 13 Residents (R1 to R13) and 5 Staff (S1 to S5). LPA toured 13 resident bathrooms showers and the Memory Care shower area.

Based on interviews 13 Out of 13 Residents (R1 to R13) stated he/she has never observed or heard about residents being required to take showers together.

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jin Jackie	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marcella Tarin	TELEPHONE: (714) 328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250609090532

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: CAMPBELL VILLAGE	FACILITY NUMBER: 435294224
	VISIT DATE: 06/16/2025

NARRATIVE

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Based on interviews, 13 Out of 13 Residents (R1 to R13) stated he/she has never observed or heard about staff mistreating residents. 13 residents state facility staff treat him/her well and have no concerns.

Based on interviews, 5 Out of 5 Staff (S1 to S5) stated he/she has never observed or heard about residents being required to take showers together. 5 staff stated he/she has never observed or heard about staff mistreating residents.

This agency has investigated the above allegations and we have found that the complaint was UNFOUNDED meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Administrator Geralyn De Ocampo, and a copy of this report was provided.

SUPERVISOR'S NAME: Jin Jackie	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marcella Tarin	TELEPHONE: (714) 328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

LIC9099 (FAS) - (06/04)

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