435200327-12-4-2025-26-AS-RMAO-DPMUQA-20251223144646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200327
Report Date: 12/04/2025
Date Signed: 12/04/2025 04:58:01 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
11/03/2025 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20251103085122

FACILITY NAME:	LORRIE RESIDENTIAL CARE HOME IV		FACILITY NUMBER:	435200327
ADMINISTRATOR:	ANGELINA ESCOBAR		FACILITY TYPE:	740
ADDRESS:	675 HIGH GLEN DRIVE		TELEPHONE:	(408) 923-2784
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95133
CAPACITY:	6	CENSUS: 5	DATE:	12/04/2025
		UNANNOUNCED	TIME BEGAN:	01:39 PM
MET WITH:	Angelina Escobar		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff member physically abused resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Administrator (ADM) Angelina Escobar.

On 11/03/2025, the Department received a complaint with the allegation that a staff member physically abused resident in care.

On 11/05/2025, the Department conducted an investigation visit. LPA interviewed ADM, 2 staff and 6 residents. LPA obtained a copy of a staff's statement, a copy of resident R1's cognitive assessment, physician report, and appraisal need and service plan.

Continue on LIC9099-C. Page 1 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

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-20251103085122

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: LORRIE RESIDENTIAL CARE HOME IV	FACILITY NUMBER: 435200327
	VISIT DATE: 12/04/2025

NARRATIVE

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On 11/05/2025, LPA interviewed 2 staff (S2, S3). Both staff stated they never heard any staff hit any resident. LPA interviewed resident R1. R1 stated staff S1 hit him/her on 11/26/2025. R1 stated S1 did not hit him/her on any other day. R1 stated no other staff hit him/her. LPA interviewed the other 5 residents (R2 - R6). 3 Out of 5 residents stated the facility staff never hit them and they never heard any staff hit residents. 2 Out of 5 residents were not responsive to LPA's questions due to neurocognitive issue or was on hospice care.

LPA interviewed Administrator (ADM) Angelina Escobar. ADM stated on 10/27/2025, resident R1's case manager (CM) visited R1 and R1 told CM that on 10/25/2025 staff S1 physically abused him/her. ADM stated CM discussed the allegation with him/her but he/she was not aware of the allegation before and did not receive any report regarding the allegation.

ADM stated S1 was off on 10/27/2025 and CM scheduled a meeting with him/her and S1. ADM stated he/she interviewed S1 on the phone on 10/27/2025. S1 denied he/she physically abused R1. S1 stated he/she just changed R1's diaper and cleaned up R1 because R1 had bowel movement. ADM stated he/she talked to R1 and assessed R1. ADM stated R1 did not have injury or skin discoloration. ADM stated R1 has history of generalized chronic pain and has behavior of yelling for pain without reason.

ADM stated on 10/30/2025, at 2:15PM, CM came to the facility and talked to R1 in private for 30 minutes. ADM stated CM then had a meeting with he/she and S1. ADM stated in the meeting, S1 stated he/she did not hit R1 and he/she just cleaned up R1 due to R1's bowel movement. ADM stated CM concluded that there was no physical abuse in the facility due to R1 has cognitive impairment.

Based on the review of S1's writing statement dated on 10/31/2025, S1 stated on 10/26/2025, R1 had large bowel movement, with R1's permission, S1 and staff S4 provided perineal care at R1's private area with soap and water, and applying protective skin barrier to help preventing irritation, rash, soreness, and redness. S1 stated during the care, R1 complained of pain in the perineal area despite the perineal care was conducted carefully and respectfully. S1 stated R1 often complained of pain when being turned or repositioned. S1 stated R1 currently has pain medication. S1 stated at the end of their shift on 10/26/2025, there were no complaint from R1 regarding the perineal care.
Continue on LIC9099-C. Page 2 of 3.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20251103085122

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: LORRIE RESIDENTIAL CARE HOME IV	FACILITY NUMBER: 435200327
	VISIT DATE: 12/04/2025

NARRATIVE

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Based on the review of R1's Cognitive Assessment Note from Family Nurse Practitioner (FNP1) dated 11/03/2025, R1 has moderate/severe neurocognitive issue.

Based on the review of the Letter of Capacity Determination for R1 from Nurse Practitioner (NP1) dated 11/19/2025, R1 has cognitive and memory impairment, and R1 has been making flirty comments frequently towards healthcare workers.

Based on the review of R1's Appraisal/Needs and Service Plan dated 07/01/2025, R1 has Chronical pain on left shoulder/left hip and bladder discomfort.

Based on the investigation report dated 11/14/2025, R1 did not sustain any visible injuries and had a complaint of pain. Staff S4 stated resident R1 always yelled in pain and R1 was very sensitive. S4 sated on 10/26/2025, he/she and S1 changed R1's diaper and cleaned R1. S4 stated he/she did not observe S1 behaved aggressively to R1. S1 denied he/she hit R1.

The Department has investigated the above allegations. Based on the investigation, record reviewed, and interviews conducted, the Department found that the above allegations are UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

No citation noted today. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.

Page 3 of 3

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

LIC9099 (FAS) - (06/04)

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