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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435200466
Report Date: 03/30/2026
Date Signed: 03/30/2026 10:54:24 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
01/15/2026 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20260115112354
FACILITY NAME:MADERA VILLA RESIDENTIAL CAREFACILITY NUMBER:
435200466
ADMINISTRATOR:TUAN, ALANFACILITY TYPE:
740
ADDRESS:1052 W. IOWA AVENUETELEPHONE:
(408) 739-7368
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:15CENSUS: 12DATE:
03/30/2026
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Administrator, Alan TuanTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are not ensuring a resident is compliant with their medications
Staff hit a resident
Resident sustained multiple bruises due to staff neglect or physical abuse
Staff is retaliating against a resident
INVESTIGATION FINDINGS:
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On March 30, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Administrator, Alan Tuan and explained the purpose of the visit.

Regarding the allegation, staff are not ensuring a resident is compliant with their medications, according to the reporting party, Resident 1 (R1) is self-neglecting by not taking his/her currently prescribed Seroquel and Zoloft due to R1's paranoia. According to the reporting party, R1 does not want to be controlled by the medications and believes the medications are poising him/her. In addition, reporting party indicated that the facility is not doing anything wrong and is reporting the medication refusals to required parties.

During the investigation, LPA reviewed R1's file, interviewed the administrator and R1's care manager. Based on R1's file reviewed, R1 has a diagnosis of dementia and anxiety disorder associated with paranoia, depressions and experiences hallucinations. According to the administrator, R1 frequently refuses prescribed medications and has been observed hiding medications in various locations, including near his/her bed and in gaps between furniture. Administrator indicated when R1 refuses medications, the private caregiver, hired by family through Sage Elder Care Solution documents the refusal and communicates with the physician, however, the facility does not have documentation of these communications, as they occur between Sage Elder Care Solutions and the POA. (continue to 9099C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
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-20260115112354
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: MADERA VILLA RESIDENTIAL CARE
FACILITY NUMBER: 435200466
VISIT DATE: 03/30/2026
NARRATIVE
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According to the Care Manager interviewed, the facility is not doing anything wrong. All medications are given as prescribed, however R1 refuses to take them. Care manager indicated that they are notified everytime R1 refuses his/her medications.

Regarding the allegation staff hit a resident and resident sustained multiple bruises due to staff neglect or physical abuse, according to the reporting party, during a video visit with R1's psychiatrist, R1 indicated he/she was assaulted and was punched by the administrator causing bruises on R1's palms and all over his/her body. No date or time was provided. Reporting party indicated that this complaint was only filed because he/she is a mandated reporter, however this allegation is unfounded because R1 has a history of making up stories.

During the investigation, LPA reviewed R1's file, interviewed the administrator and R1's care manager. Based on R1's file reviewed, R1 has a diagnosis of dementia and anxiety disorder associated with paranoia. According to the administrator, he denied this allegation and indicated he has not had physical contact with R1 nor has he observed any visible bruises on R1. In addition, the Care Manager and private caregiver from Sage Elder Care Solutions did not observe any bruises or injuries and no staff, caregivers, or other parties independently reported concerns of abuse to either of them.

Regarding the allegation, staff is retaliating against a resident, according to the reporting party, the administrator is retaliating against R1 and victimizing R1 because of the complaints previously made. No further information is forthcoming. Reporting party indicated that this complaint was only filed because he/she is a mandated reporter, however this allegation is unfounded because R1 has a history of making up stories.

During the investigation, LPA interviewed the administrator and care manager. According to the administrator, he denied this allegation and indicated that R1 makes accusations against him and the staff, however for most of the day, R1 has a private caregiver that provides care to R1 and for hours that there is no private caregiver, R1 remains in his/her room and two facility staff attend to her when required. According to the Care Manager, R1 has not provided them with specific retaliatory action by facility staff. Care Manager indicated that he/she has not personally witnessed any retaliation and indicated that the facility is not doing anything wrong. Due to R1's behaviors, R1 has a history of making up stories.

Based on the above information, the Department has found that the above allegations are to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Report is reviewed with administrator and a copy is provided.
SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2