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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435294246
Report Date: 12/01/2025
Date Signed: 12/01/2025 11:35:11 AM

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
11/25/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20251125121111
FACILITY NAME:SHAMROCK RESIDENTIAL CARE HOMEFACILITY NUMBER:
435294246
ADMINISTRATOR:ABLAO, VICKYFACILITY TYPE:
740
ADDRESS:1025 SHAMROCK DRIVETELEPHONE:
(408) 879-9603
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:6CENSUS: 4DATE:
12/01/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee Vicky AblaoTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff financially abused resident in care.
Staff did not provide resident with a copy of the Admission Agreement.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct the initial complaint investigation visit. LPA met with Licensee (LIC) Vicky Ablao. LPA stated the purpose of the visit.

On 11/25/2025 the Department received a complaint with the above allegations.

On 11/25/2025, LPA Tarin interviewed the Reporting Party (RP). RP states he/she spoke with Resident R1, referred to as R1, on 11/18/2025 and R1 stated he/she had moved into the facility and had wire transferred $15,500 to the facility. RP stated he/she did not have any documentation of the wire transfer in the amount of $15,500. RP stated R1 also stated he/she was not provided an Admission Agreement when he/she moved into the facility on 11/18/2025. RP stated he/she did not have any additional details regarding the transaction or the admission agreement.

Page 1 of 2
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
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 2
Control Number 26-AS-20251125121111
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: SHAMROCK RESIDENTIAL CARE HOME
FACILITY NUMBER: 435294246
VISIT DATE: 12/01/2025
NARRATIVE
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On 12/1/2025 LPA Tarin interviewed R1. R1 states he/she did not know how long he/she lived at the facility, stating "I think it was about 2 weeks ago." R1 stated he/she remembers signing the Admission Agreement and 'went willingly with the Administrator to the bank and I knew it was so that I could live here (facility)." R1 states he/she is responsible for his/her own money. R1 stated he/she did not have bank records or do online banking. R1 stated he/she goes into the bank to conduct all his/her finances. R1 showed LPA an envelope that contained the Admission Agreement dated and signed on 11/18/2025.

On 12/1/2025 LPA interviewed Licensee (LIC). LIC states R1 moved into the facility on 11/18/2025 and signed the facility agreement. LIC states R1 handles his/her own fiances. LIC states he/she was not aware of any financial abuse of R1 since moving into the facility. LIC states R1 is current with his/her facility payments through 12/2/2025.

Review of R1's Admission Agreement, R1 signed the Admission Agreement on 11/18/2025, agreeing to $300 a day for 15 days, totaling $4,500. LPA also reviewed an invoice dated 11/18/2025 for R1 in the amount of $4,500 for 11/18/2025 to 12/2/2025 (15 days), and a payment made by R1 by 'Chase Counter Check' on 11/19/2025.

Review of R1's Physician's Report dated 11/18/2025, R1 does not have neurocognitive disorder.

This agency has investigated the complaint alleging staff financially abused resident in care, and staff did not provide resident with a copy of the Admission Agreement. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2