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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430708736
Report Date: 09/28/2024
Date Signed: 09/28/2024 02:53:21 PM

Unsubstantiated


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
02/27/2023 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20230227150412
FACILITY NAME:VILLA VERDEFACILITY NUMBER:
430708736
ADMINISTRATOR:JULIETA EXTRAFACILITY TYPE:
740
ADDRESS:4751 CALLE DE TOSCATELEPHONE:
(408) 978-7937
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:6CENSUS: 4DATE:
09/28/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee, Dominica OliviaTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff confronted and yelled at a resident.
Facility staff argued disregarding resident's personal rights.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Licensee, Dominica Olivia and stated the purpose of today’s visit.

On 2/27/2023, the Department received a complaint with the above allegations. On 3/9/2023, the Department conducted an initial investigation at the facility.

Continuation on LIC 9099-C, Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2024
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-20230227150412
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: VILLA VERDE
FACILITY NUMBER: 430708736
VISIT DATE: 09/28/2024
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
Page 2 of 2.

Staff confronted and yelled at a resident. /Facility staff argued disregarding resident’s personal rights.

It was alleged on 2/18/2023, resident R1 informed staff S2 about staff S1 yelling at R1 and stating, “caregivers at the home does not like to take care of you”. Staff S2 reassured R1 that the statement was not true. S1 confronted S2 in front of R1 stating R1 was lying and both staff were yelling at each other.

On 3/9/2023, the Department interviewed 3 staff. Three out of three staff stated the staff do not yell at the residents or yelling in front of the residents. S1 stated he/she has a deep voice and people misinterpret his/her voice as “yelling”. S1 stated R1 misunderstood the statement made on 2/18/2023 and want to explain to R1 that R1 is delicate, and they want to ensure the facility staff do not hurt R1.

On 3/9/2023, the Department interviewed 3 residents. Two out of three residents stated staff do not yell at residents. R1 stated staff S1 yells and raises the voice towards R1 but S1 is better now. R2 and R3 stated they have heard staff argue with each other but cannot recall the staff names and when it had occurred.

On 3/9/2023, the Department interviewed 1 visitor (V1) at the facility. V1 stated he/she comes to the facility 3 times a week and has not observed or heard staff yelling or arguing with the residents or staff.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee, Dominica Olivia and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2