415601066-5-14-2025-14-AS-KHOS-DGTMWX-20250519095905

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601066
Report Date: 05/14/2025
Date Signed: 05/14/2025 12:27:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2024 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20241107162441

FACILITY NAME:	A & J ASSISTED LIVING FACILITY		FACILITY NUMBER:	415601066
ADMINISTRATOR:	PACALDO, JULIET		FACILITY TYPE:	740
ADDRESS:	130 VALE STREET		TELEPHONE:	(650) 755-0411
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY:	53	CENSUS: 51	DATE:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Assistant Administrator, Gabriel Mendoza		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff touched resident inappropriately

INVESTIGATION FINDINGS:

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On May 14, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Assistant Administrator, Grabriel Mendoza and explained the purpose of the visit.

Regarding the allegation, staff touched resident inappropriately, according to the reporting party, Resident 1 (R1), there has been two separate incidents where Staff 1 (S1) inappropriately touched R1's private parts.

During the invesitgation, the Department reviewed R1's file, interviewed residents and staff. According to R1, during the evenings while S1 would change R1’s diaper, S1 used the palm of his/her hand to rub R1’s private part three separate times, however there were no witnesses the first two time and the third time there was another staff member (S2) present. According to S1 and S2, he/she denies this allegation. S2 indicated that R1 requires two staff assist as R1 is bedridden. In addition, S2 indicated that indicated R1 often accuses staff of hurting them when they are just trying to change R1’s diaper and clean up R1’s bowel movement. The Department concluded the investigation and there is no evidence to prove or disapprove that R1 was inappropriately touched by S1.

Based on interviews conducted and information collected, the department has determined that although the above allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed with Assistant Administrator, Gabriel Mendoza and a copy is provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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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