<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202640
Report Date: 05/09/2025
Date Signed: 05/09/2025 12:11:46 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
03/12/2025 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20250312103645
FACILITY NAME:CJCP RCFEFACILITY NUMBER:
435202640
ADMINISTRATOR:GONZAGA, MARITESFACILITY TYPE:
740
ADDRESS:678 HIGH GLEN DRTELEPHONE:
(408) 770-9453
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY:6CENSUS: DATE:
05/09/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Marites Gonzaga Administrator TIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator has made inappropriate gestures and speech towards resident
Administrator transported resident to bank without resident's wheelchair, forcing the resident to ambulate with a walker.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/09/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver the findings of the investigation. LPA met with Administrator Marites Gonzaga.

On 03/12/25 the department received a complaint alleging that the facility staff (S3), made inappropriate gestures to the resident and transported resident without the resident's wheelchair, forcing the resident to ambulate with a walker.

Based on document review of 3 resident’s file, LPA observed that R1 is allowed to ambulate with a 4 point cane for short distances.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
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-20250312103645
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: CJCP RCFE
FACILITY NUMBER: 435202640
VISIT DATE: 05/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed 2 staff (S1, S2) ADM was also interviewed and 3 residents (R1, R2 & R3). 3 Out of 3 residents stated the facility staff did not make inappropriate gestures or used offensive language. 2 Out of 2 staff, stated they did not witness or hear, Administrator make inappropriate gestures or used foul language toward resident.

Based on interviews and record review, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. Therefore, the above allegation is unsubstantiated.

No deficiencies cited during today’s visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Administrator Marites Gonzaga And a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2