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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435200791
Report Date: 09/30/2024
Date Signed: 10/02/2024 07:50:49 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
04/30/2024 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20240430100728
FACILITY NAME:CONSTANTIN'S CARE HOMEFACILITY NUMBER:
435200791
ADMINISTRATOR:LAPUSTEA, CONSTANTINFACILITY TYPE:
740
ADDRESS:5836 ETTERSBERG DRIVETELEPHONE:
(408) 229-0365
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:6CENSUS: DATE:
09/30/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Constantin Lapustea - Licensee/AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Questionable death
Staff is physically abusive to residents
Staff made inappropriate comment(s) to resident
Staff does not change resident's clothes
Facility smells of urine
Staff serves expired food
Staff did not seek timely medical attention to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to deliver the findings of the above allegations. LPA met with licensee/administrator (LIC/ADM) Constantin Lapustea and stated the purpose of the visit.

On 4/30/2024 - The department received a complaint alleging that there was questionable death, staff was physically abusive to residents, staff made inappropriate comment(s) to resident, staff serves expired food, staff did not provide meal to resident and staff did not seek timely medical attention to residents. This allegation is connected to complaint filed on 4/29/2024 referencing complaint #26-AS-20240429110546

On 5/1/2024, the Department conducted an investigation of the allegation(s).

page 1 of 4 see LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
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 4
Control Number 26-AS-20240430100728
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: CONSTANTIN'S CARE HOME
FACILITY NUMBER: 435200791
VISIT DATE: 09/30/2024
NARRATIVE
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Questionable death
Based on record review, and interviews - Physician (MD) stated that the resident (R7) had a medical condition that is "not very common and does not have exact statistics." Physician stated depending on the cause it could be prevented and it can also not be prevented. It can happen for different reasons..." Based on record review, R7s condition has unknown etiology.

Staff is physically abusive to residents
On 4/29/2024 - LPAs interviewed R1 to R6, they did not witness staff physically abuse a resident. R1 did not engage in conversation with LPAs R1 spouse was in the facility visiting at the time of the visit and stated will not let anyone get in trouble. R2 stated staff are friendly, however, R2 stated there was a time when a staff was rough with resident, but does not remember when it happened. R3 stated, "it's not abusive, the situation was difficult because it's not easy to care for R1." R4 stated no issues with staff. R5 stated did not observed being rough to a resident, staff are fine. R6 stated staff are good.

On 5/1/2024 - LPA interviewed S1. S1 stated R1 became very lethargic at one time and it scared S1. S1 tried to wake R1 and put cold towel to wake R1. S1 demonstrated the tapping to LPA to wake R1.

Staff made inappropriate comment(s) to resident
On 4/29/2024 - LPA interviewed W1, and stated he/she heard LIC/ADM call R4 stupid, over and over again. W1 stated no one else witnessed the incident because everyone was in the kitchen. R1 does not want to engage in conversation, R2 stated staff are friendly. R4 stated no issues with staff. R5 stated no comment to add. R6 stated he doesn't know.

Based on the written statement of W1 dated 8/19/2024. W1 did not state the date and time when the incident happened.

page 2 of 4
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20240430100728
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: CONSTANTIN'S CARE HOME
FACILITY NUMBER: 435200791
VISIT DATE: 09/30/2024
NARRATIVE
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Staff does not change resident's clothes
On 4/30/2024 LPA interviewed W1 who stated "unless R6 clothes are super filthy that's the only time staff will change R6. R6 uses the same sweats during the weekend, R6 is not allowed to wear clothes that R6 wants to wear. R6 can say no and can refuse."

On 5/1/2024 LPA interviewed LIC/ADM, and stated that resident do not change clothes everyday but every other day.

On 5/1/2024 LPA interviewed S2 and stated "we wash their clothes, they change clothes, but if they don't want to change we cannot force them."

LPA Partoza visited and inspected the facility on the following dates 4/28/24, 4/29/24 5/1/24 and 5/29/2024. During the visit LPA observed R1 had different clothes 3 occasions. On 4/29/24 R1s spouse was present and stated R1 has few clothes. On 4/29/2024 LPA observed R6 was wearing the clothing worn on 4/28. On 5/1/2024 LPA observed R6 changed 3 times. R3 has clothes on bed and R3 stated he likes to choose his clothes. R2 stated he/she changes clothes everyday. LIC/ADM stated that they assist residence with showering and changing clothes.

Facility smells of urine
On 5/1/2024 LPA Interviewed LIC/ADM and S2. LIC/ADM stated diapers are changed all the time or when wet, they do not leave the resident wet or soaking especially when it's getting hot, the bedding is changed every week, sheets are changed everyday if necessary, specially if it's wet. S2, we do once a week bedsheet change.

On 5/1/2024 LPA interviewed R2 and R3. R2 stated sheets are washed every week. R3 stated they put pads and washes the sheet each week.

LPA Partoza, visited the facility on 4/28/24, 4/29/24, 5/1/24 and 5/29/24. LPA inspected the facility and residents room (R1 to R6). R1 and R3 shares a bedroom and a bathroom. LPA inspected 2 bathrooms and R2, R3, R4, R5, and R6 room and observed rooms to be organized and sanitary.

page 3 of 4
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20240430100728
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: CONSTANTIN'S CARE HOME
FACILITY NUMBER: 435200791
VISIT DATE: 09/30/2024
NARRATIVE
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Staff serves expired food
On 4/28/24, 4/29/24, 5/1/24 and 5/29/24. LPA inspected the pantry and refrigerator.
LPA observed fruits and vegetables. Bread that was recently bought. LPA observed 2 days of non-perishable food and 7 days of non-perishable food.

On 5/1/2024 - LPA interviewed R2, R3 and R4. R2 stated there's food fruits for snacks, healthy dinner made and cooked by S1. R3 stated there's always food. R5 no expired food served.

On 5/1/2024, LPA interviewed S1, S2 and ADM. S1 stated,"I have eggs for breakfast or I go by preference of the resident. I make jams from scratch." S2 stated, S1 takes care of meals and do grocery shopping at least once a week.

Staff did not seek timely medical attention to residents.
Based on document review and interview, MD stated "it would be difficult to judge how severe symptoms are, especially if R7 cannot clearly express the discomfort. It could happen quickly depending on what's happening leading up to R7's condition."

On 7/9/2024 - S1 was interviewed and stated that on 12/14/2023 there was a delay because the family was attempting to arrange a respite or hospice evaluation. S1 stated they (S1 and ADM) grew concerned and prompted them to take R7 to the hospital.

On 7/9/2024 - Responsible Party (RP) was interviewed, and stated that staff called on 12/13/2023 and asked what they should do. RP does not remember instructing to take R7 to the hospital. RP stated there was communication issues with the hospital and the facility on the next steps.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Licensee/administrator Constantin Lapustea and a copy of the report was provided.

page 4 of 4
End of report
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
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: 4 of 4