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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202376
Report Date: 08/04/2025
Date Signed: 08/05/2025 03:40:36 PM

Substantiated


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
09/10/2024 and conducted by Evaluator Simranjit Rai
COMPLAINT CONTROL NUMBER: 26-AS-20240910164317
FACILITY NAME:BONNEVIE RESIDENCE AND CAREFACILITY NUMBER:
435202376
ADMINISTRATOR:RAMIRO CUSTODIOFACILITY TYPE:
740
ADDRESS:555A MC LAUGHLIN AVENUETELEPHONE:
(408) 931-6077
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:6CENSUS: 4DATE:
08/04/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee/Administrator (ADM) Merclo Garcia TIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Resident is being financially abused

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Licensee/Administrator (ADM) Merclo Garcia and stated the purpose of today’s visit.

On 9/10/2024, the Department received a complaint with the above allegation. On 9/13/2024, the Department conducted an initial investigation at the facility. It was alleged resident (R1) was financially abused on 9/1/2024 when R1 gave S1 cash ($500) to play at the casino. S1 drove R1 to the casino and R1 contributed to paying for gas to and from the casino.

Continuation on LIC 9099-C, Page 1 of 3.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
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 4
Control Number 26-AS-20240910164317
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: BONNEVIE RESIDENCE AND CARE
FACILITY NUMBER: 435202376
VISIT DATE: 08/04/2025
NARRATIVE
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Page 2 of 3.

On 09/13/2024, the Department interviewed ADM. ADM stated he was not aware of staff driving residents(s) to casino. ADM stated R1 is accompanied by facility staff when R1 needs to go for personal errands which includes but not limited to getting a haircut, going to the mall, going to the bank and visiting family. ADM stated staff S2 is the main staff who drives and accompany R1 during these runs.

On 9/13/2024, the Department interviewed R1. R1 stated that on 9/1/2024, he/she offered S1 $500 to use at the casino which S1 accepted. R1 stated the money offered was a loan that S1 will pay back. R1 stated that he/she feels bad because staff at the facility always complain about financial issues and R1 felt pressured to give money to S1. R1 stated the staff tells him/her to buy food for everyone at the facility through Door Dash. On 12/19/2024, R1 further stated ADM was aware of the trip to the casino prior to 9/1/2024 and did not allow S1 to accompany R1. R1 stated S1 still took R1 to the casino.

On 9/26/2024, the Department conducted an interview with R1 to clarify the statements made earlier to the Department. R1 stated that he/she wanted to go to the casino to celebrate and offered $500 to S1 so S1 can play at the casino with R1. R1 also stated that S1 gave back the money the next day.

On 9/26/2024 the Department interviewed S1, S1 stated that he/she instructed R1 to ask permission from his/her family prior to going to the casino and if R1 family consents to the trip then they will go to the casino. S1 admitted to accepting the money offered by R1 on 9/1/2024 to gamble at the casino, however, S1 stated the money was offered by R1 as a loan and to be paid back the next day to R1. S1 stated he/she returned the money to R1 the next day. S1 stated he/she informed ADM a week later.

On 10/16/2024 the Department interviewed R1s family member (F1) who stated that R1 told him/her of his/her trip to the casino with S1 and stated that R1 loaned money to S1 and was paid back the next day.

On 2/28/2025 the department reviewed R1s ATM transaction statement and based on review of R1’s statement, R1 orders food online by using third-party vendors such as Door Dash from his/her mobile device. Based on review of the transaction the amount spent on food cannot be determined if R1 bought food for the whole facility or if food that was ordered was based on R1s preference.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20240910164317
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: BONNEVIE RESIDENCE AND CARE
FACILITY NUMBER: 435202376
VISIT DATE: 08/04/2025
NARRATIVE
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Page 3 of 3.

On 4/9/2025, the Department interviewed ADM. ADM stated that R1 will sometimes refuse to eat what they serve and would rather buy his/her own food using his/her cell phone and would order online. ADM stated after the incident, there were no issues raised between staff and residents and R1 found a new place and moved out of the facility early this year.

Based on review of R1’s bank statements, R1 is transferring money to a third-party vendor which is being used to make purchases of food. On 12/19/2024 LPA Rai obtained documents of the transactions occurring on the third-party vendor wherein resident made purchases of food from Door Dash from August 2024 to September 2024.

Based on inspection and investigation, the department determines that although a resident extended a financial loan to a staff, facility employees or staff are not permitted to engage in borrowing from or allowing residents to make purchases such as food for residents or staff within the facility. In addition, the resident and licensee does not have an written agreement regarding handling resident's finances and loaning money from residents. Therefore, the preponderance of evidence standard has been met, the above allegation is found to be SUBSTANTIATED.



Deficiencies were cited from California Code of Regulations, Title 22, please see LIC 9099-D.

This report was reviewed with Administrator and a copy of the report was provided. Appeal Rights were provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20240910164317
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: BONNEVIE RESIDENCE AND CARE
FACILITY NUMBER: 435202376
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2025
Section Cited
HSC
1569.269(29)(E)
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HSC1569.269(29)... a licensee, or a spouse, domestic partner, relative, or employee of a licensee, shall not do any of the following:(E) Enter into a loan or promissory agreement or otherwise borrow money from a resident without outlining the terms of the repayment being given to the resident.
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Licensee/Administrator stated to submit a written plan of action understanding regulation and staff training will be completed by POC due date. Licensee/Administrator agreed and understood.
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This requirement is not met as evidenced by: Based on interview review, R1 and licensee does not have an written agreement regarding handling R1's finances and loaning money from residents which pose/poses an immediate health, safety, and personal right risks to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4