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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 08:22:55 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
04/29/2024 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20240429110546
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: 6DATE:
09/30/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Constantin Lapustea - Licensee AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Staff forced resident to wear denture
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannouced complaint investigation of the above allegation and met with licensee/administrator (ADM) Constantin Lapustea and stated the purpose of the visit.

On 4/29/2024 - The department received a complaint alleging staff forced resident to wear dentures.
LPAs Partoza and Monter conducted an initial investigation on the same day the complaint was received and interviewed witness 1 (W1), residents (R1 to R6) and staff (S1 to S2), ADM, and visitor (W2) of R1.

page 1 of 2, 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 2
Control Number 26-AS-20240429110546
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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On 4/29/2024 LPA interviewed residents 1 to 6 (R1 to R6), based on interview, R1 did not respond to questions, W2 however, spoke in behalf of R1. W2 stated that he/she visits R1 on a regular basis at least 2 to 3 times a week at random days and time and R1 will not say anything, R1 does not like anyone to get in trouble, R1s spouse stated he/she did not see any visible sign of abuse. R2 stated S1 used the right hand to open R1s mouth to put in the denture, R2 stated "I can't describe how hard or forceful it was but, R1 is bigger than S1." R2 does not recall when the incident occurred. R3 stated he/she seen the staff put the dentures in, "but it was not abusive." R4 stated he/she did not see staff forcefully put dentures inside a resident's mouth. R5 stated he/she did not see staff forcing a resident to wear dentures. R6 stated no, and doesn't know. S1 stated sometimes they request for the dentures, and R1 will refuse. S1 stated R1 has been able to manage dentures for a long time. ADM stated they cannot force R1, if R1 refuses to wear dentures. S2 stated, R1 will sometimes refuse to put on dentures.

On 5/1/2024 - LPA Partoza conducted an interview with W1. W1 stated they told S1 not to force R1 to wear dentures if R1 doesn't want to. S1 stopped and no longer forced R1 to use dentures. W1 stated that he/she could not remember when it happened.

Based on the written statement of R2 dated 4/29/2024, R2 did not state the date and time of the incident and if there was any visible sign of physical injury to R1.

Based on the written statement of W1 dated 8/19/2024. W1 did not state the date, time of the incident and if there was any visible sign of physical injury to R1.

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 (LIC/ADM) Constantin Lapustea and a copy of the report was provided.

page 2 of 2
end of report
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: 2 of 2