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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201229
Report Date: 12/08/2025
Date Signed: 12/08/2025 02:20:39 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
07/10/2025 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20250710151220
FACILITY NAME:LOVELY CARE HOMEFACILITY NUMBER:
435201229
ADMINISTRATOR:ELIZA DAQUIOAGFACILITY TYPE:
740
ADDRESS:3640 HEATHCOT COURTTELEPHONE:
(408) 531-9515
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY:6CENSUS: 5DATE:
12/08/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH: Administrator (ADM) Eliza DaquioagTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is not meeting the hygiene needs of residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator (ADM) Eliza Daquioag.

Facility is not meeting the hygiene needs of residents in care

On July 10, 2025, the Department received a complaint alleging Facility is not meeting the hygiene needs of residents in care. It has been alleged that resident R1 was observed with multiple diapers.

On July 11, 2025, LPA interviewed Witness W1 and W2. Both witnesses interviewed stated they have observed resident R1 wearing multiple diapers at the same time, on at least 5 different occasions. W1 and W2 stated they were told by the ADM to use multiple diapers on resident R1.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025
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 2
Control Number 26-AS-20250710151220
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: LOVELY CARE HOME
FACILITY NUMBER: 435201229
VISIT DATE: 12/08/2025
NARRATIVE
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On July 15, 2025, LPA Monter interviewed residents R1-R3. All residents interviewed were unable to respond to questions about complaint allegations due to their neurocognitive disorders.

On July 15 & 24 and August 13, 2025, LPA Monter interviewed Staff S1 and S2. Both admitted they were using multiple diapers on R1, due to R1’s urination, which soils his/her bed and the resident him/herself. S1 stated if residents R1 or R2 get wet at night, they will use 3-4 diapers. S2 stated only R1 has multiple diapers at night. Both staff interviewed acknowledged there wasn’t a difference between R1 soiling him/herself at night or during waking hours.

On July 15 & 24 and August 13, 2025 LPA interviewed ADM. ADM admitted staff place double diapers on R1 at night. ADM stated Only R1 has 2 diapers, because he/she has heavy urination. LPA asked ADM if there is a discrepancy with R1 when he/she soils him/herself in the morning, evening or night. ADM acknowledged that there wasn’t a difference. ADM stated R1 has two diapers at night because at night is easier to take it off and change him/her when he/she has 2 diapers. ADM stated she did instruct her staff to put 2 diapers on R1 at night.

Based on a review of R1's Appraisal / Needs and Services Plan (ANS), dated May 28, 2025, R1 has episodes of yelling, screaming and hitting staff. Furthermore, the ANS states R1 needs 2 people during care. The ANS does not outline a specific bowel and bladder management plan for resident R1.

The Department has completed the investigation of the above allegation. Based on interviews conducted and records review, the department has found that the above allegation were UNFOUNDED, meaning that the allegation was false, could not have happened and/or are without a reasonable basis.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2