<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435294351
Report Date: 02/19/2025
Date Signed: 02/19/2025 05:01:26 PM

Substantiated


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
06/21/2024 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20240621154956
FACILITY NAME:SWEET DREAMS CARE HOME LLCFACILITY NUMBER:
435294351
ADMINISTRATOR:JEAN JOSEFACILITY TYPE:
740
ADDRESS:1187 PARK GROVE DRIVETELEPHONE:
(408) 941-9995
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:6CENSUS: 5DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Jean JoseTIME COMPLETED:
04:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is unable to comprehend resident's request and needs in English.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Administrator (ADM) Jean Jose.

On 6/21/2024, the Department received a complaint with the allegation that a facility staff is unable to comprehend resident's request and staff's instruction in English to provide care to residents.

On 6/28/2024, the Department conducted an initial investigation visit. LPA interviewed ADM, a staff (S1), and 6 residents.

LPA request resident roster and LIC 500 Personnel Report, and a copy of S1's profile documents.

Continue on LIC9099-C. Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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-20240621154956
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: SWEET DREAMS CARE HOME LLC
FACILITY NUMBER: 435294351
VISIT DATE: 02/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 6/28/2024, LPA met and interviewed staff S1. LPA asked questions such as but not limited to "What is your name?" "How long do you work for the facility?" S1 was unable to answer the questions rather he/she
used hand gesture to be suggested the use of "google translator" to communicate on his/her cell phone. LPA and S1 used google translator software on S1's cell phone to communicate. S1 stated he/she cooks the meals for residents and cleans the facility including resident rooms. S1 feeds residents and helps residents for showers. S1 stated that he/she uses body language/gesture to communicate with residents.

On 6/28/2024, LPA interviewed witnesses (W1 to W7). W1 to W7 except W4 and W5, shared same sentiments about S1’s inability to communicate in English wherein they had to use body language/gestures to communicate and had concerns in particularly during emergency situations. W4 and W5 were not able to respond due to neurocognitive disorder.

The Department has investigated the above allegation. Based on documents reviewed, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED.

Citations was noted today. Please see LIC9099-D. Appeal right was provided. Exit interview was conducted with ADM. A copy of the report was provided to ADM.

Page 2 of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20240621154956
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: SWEET DREAMS CARE HOME LLC
FACILITY NUMBER: 435294351
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2025
Section Cited
CCR
87411(a)
1
2
3
4
5
6
7
87411 - Personnel Requirements - (a) Facility
personnel shall at all times be sufficient in
numbers, and competent to provide the
services necessary to meet resident needs.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Administrator agreed to send plan of correction by the POC due date to ensure the facility to hire competent staff to provide care and service to residents in care.
8
9
10
11
12
13
14
Based on interview with witnesses, staff S1 is unable to comprehend English, and inability to communicate in English wherein they had to use body language/gestures to communicate.
8
9
10
11
12
13
14
The facility already sent the plan of correction on 2/20/2025.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3