435294351-1-14-2026-26-AS-RMAO-DQNV68-20260125150908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435294351
Report Date: 01/14/2026
Date Signed: 01/14/2026 09:56:36 AM

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
09/05/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250905090049

FACILITY NAME:	SWEET DREAMS CARE HOME LLC		FACILITY NUMBER:	435294351
ADMINISTRATOR:	FERNANDEZ, DIVINA		FACILITY TYPE:	740
ADDRESS:	1187 PARK GROVE DRIVE		TELEPHONE:	(408) 941-9995
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	6	CENSUS: 6	DATE:	01/14/2026
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Administrator Divina Fernandez		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Resident was unlawfully evicted.
Administrator did not safeguard resident's personal belongings.
Staff used resident's personal belongings for other residents to use.
Administrator did not communicate with responsible party regarding resident's care needs.

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) Divina Fernandez

On September 5, 2025 the Department received a complaint alleging Administrator did not communicated with responsible party regarding resident's care / Administrator did not follow eviction procedures.

On September 11, 2025, Licensing Program Analyst Steve Chang interviewed Administrator (ADM) Divina Fernandez. ADM stated R1 cannot administer insulin by him/herself, and the facility does not have professional staff to provide the insulin injection.

Page 1 Out of 6.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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 6

Control Number 26-AS-20250905090049

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: SWEET DREAMS CARE HOME LLC	FACILITY NUMBER: 435294351
	VISIT DATE: 01/14/2026

NARRATIVE

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LPA Steve Chang interviewed Staff S1 and S2. Staff S1 stated R1 needs to use insulin and can administer it him/herself. S1 stated the facility he/she communicated with R1’s Family Member (FM) when he/she visited the facility.

S2 stated R1 is forgetful recently so it is difficult for R1 to do the insulin injection because he/she cannot adjust the volume of insulin. S2 stated home health also stated R1 might not be able to do insulin by him/herself. S2 stated he/she discussed with hospital social worker about R1's insulin injection problem. S2 stated the facility told R1's family that R1's family needed to come to the facility to help R1's insulin injection 3 times per day if R1 returns to the facility.

On December 22, 2025, LPA Manuel Monter interviewed R1’s Family Member (FM). FM stated R1 had gone to the hospital, and they were going discharge R1, But FM was informed that the facility was concerned about R1 taking his/her insulin. FM stated she was informed by the facility that there wasn’t a person who would be able to administer the insulin. FM stated he/she was informed by the facility that R1 wasn’t administering his/her medication consistently and was having trouble. FM stated that it wasn't true that R1 could not could administer his/her own medication and believed it wasn't an issue. FM stated he/she can’t say there wasn’t communication regarding R1's eviction. FM stated they were not actively communicating with him/her. FM stated the facility didn’t help him/her with R1’s new placement. FM stated he/she wasn’t provided with an eviction letter.

On December 22, 2025, LPA Manuel Monter interviewed ADM Davina Fernandez. ADM stated regarding R1; he/she was sent to the emergency room on July 28, 2025. ADM stated based on a conversation with the case manager of the hospital, R1 would require a higher level of care. ADM stated the issue at hand was R1’s ability to administer his/her insulin. ADM stated R1 needed to administer his/her own insulin 3 times a day. ADM stated R1 had days when he/she was not able to administer his/her own insulin. Furthermore, since R1’s hospitalization, R1 had become weaker and the issue of insulin administration would persist. ADM stated if R1 got sick or was unable to administer his/her own medication, the facility would not be able to administer his/her insulin.

ADM stated they don’t have a licensed professional to administer the insulin. ADM stated the facility was not able to meet the needs of the R1, since he/she was not able to administer his/her own medication. ADM stated R1 was not evicted, ADM stated R1 was just needed to be moved to a facility that was a higher level of care and FM agreed and choose to move R1 to another facility. Page 2 Out of 6.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 26-AS-20250905090049

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: SWEET DREAMS CARE HOME LLC	FACILITY NUMBER: 435294351
	VISIT DATE: 01/14/2026

NARRATIVE

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ADM stated FM visits the facility once a week. ADM stated she and FM’s are in communication. Furthermore, FM was notified when R1 had been sent to the hospital. ADM stated the hospital, FM and the facility was in communication. ADM stated FM was aware of the issues that were highlighted by the facility.

On December 26, 2025, LPA Manuel Monter interviewed R1. R1 stated he/she was evicted due to his/her insulin administration and the facility stating he/she was unable to administer his/her own insulin. R1 stated he/she can administer the medication him/herself. R1 stated there hasn’t been a time, when he/she needed facility staff to administer his/her insulin medication for him/her. During visit LPA observed R1 administering his/her own insulin.

On January 7, 2026, LPA Manuel Monter interviewed Witness W1. W1 stated the reason why R1 was not discharged to sweet dreams due to the facility not being able to meet R1’s level of care. W1 stated he/she was informed by the facility that they don’t have any nurses and could not provide assistance with insulin administration. W1 stated when he/she received this case, there was back and forth between him/her, the ADM and R1’s FM. W1 stated FM was concerned with the monthly payments and couldn’t afford to move R1.

W1 stated based on what the family told him/her, R1 was able to administer his/her insulin with help with family. W1 stated they were relying on the family to do it. W1 stated when R1 moved to the facility, FM was supposed to assist with the insulin administration. W1 stated he/she was informed by the ADM that FM wasn’t coming consistently to administer insulin. W1 stated there was a lot of going back and forth for over a year regarding medication administration. W1 stated Kaiser helped in searching for possible higher level of care homes for R1. W1 stated FM was introduced to a new facility and agreed.

The Department reviewed Resident R1's Physician's Report, dated May 9, 2025. R1 is able to: administer his/her own medication, administer his/her own injections, able to perform own glucose testing.

The Department reviewed Home Health Visit Report Forms regarding R1. Home Health Visit Report dated July 21, 2025 states R1 sometimes confuses the dosage of his/her insulin. Home Health Visit Report dated July 24, 2025 states R1 refused to take 3 medications. The report also states, "if R1 needs constant monitoring, this facility is not the place for him/her. "

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 26-AS-20250905090049

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: SWEET DREAMS CARE HOME LLC	FACILITY NUMBER: 435294351
	VISIT DATE: 01/14/2026

NARRATIVE

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The Department reviewed R1’s Physician’s Report, dated August 27, 2025. The physician’s report states, R1 is able to: administer his/her own medication, administer his/her own injections, able to perform own glucose testing.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

Facility staff touched and or used resident's personal belongings / Administrator did not safeguard resident's personal belongings.

On September 5, 2025 the Department received a complaint alleging Facility staff touched and or used resident's personal belongings / Administrator did not safeguard resident's personal belongings. It has also been alleged that the facility is using R1’s personal property for other residents use.

On September 11, 2025, LPA Steve Chang interviewed staff S1 and S2. S1 stated R1's Family Member (FM) came to the facility 2 weeks ago to pick up R1's belongings. S1 stated R1's medication was returned R1's FM. S1 stated R1's FM sent a box of wipes to the facility after R1 was sent to hospital. S1 stated the next day R1's FM picked up the box. S1 stated sometimes R1 ordered from Amazon. S1 stated he/she gave R1 the packages when they arrived. S1 stated he/she open packages for the residents when they asked for the help, and opened the package in front of the resident. S1 stated he/she did not use R1's diapers for other residents.

S2 stated the facility policy regarding packages, is for staff open the package in front of residents if residents asked to open package for them. If residents are not in the facility then staff put the packages in resident's room. S1 stated he never opened R1's package or other residents' package.

On December 22, 2025, LPA Manuel Monter interviewed staff S1 and S3. S1 stated facility staff do not take the residents property. S1 stated staff do not touch or take the residents property. S1 stated if a resident’s package arrives, then the facility staff will not open the package. S1 stated the staff don’t take residents property for the use of other residents. S1 stated R1’s family member already picked up all of resident R1’s property, medications and other personal property. Page 4 Out of 6.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 26-AS-20250905090049

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: SWEET DREAMS CARE HOME LLC	FACILITY NUMBER: 435294351
	VISIT DATE: 01/14/2026

NARRATIVE

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Staff S3 stated when packages arrive, they will put the boxes in the residents room. S3 stated he/she has never seen staff take the residents property. S3 stated staff will open the residents boxes, if the residents ask for that assistance. S3 stated staff do not take the property of one resident and give it to another resident to use.

LPA Manuel Monter interviewed Administrator (ADM) Divina Fernandez. ADM stated she or the facility staff do not take the residents property. ADM stated she and the facility staff do not give other residents property to other residents to use. ADM stated when a package / letter arrives, the staff will give that mail/package to the resident. ADM stated staff don’t open residents mail/packages. ADM stated if a resident requests to have a package open, then staff will open the package for them. ADM stated the other residents have their own supplies. ADM stated the facility also has its own in house supplies. ADM stated furthermore, R1’s supplies are extra large and wouldn’t fit the other residents. ADM stated R1’s Family Members already picked up R1’s things.

LPA Manuel Monter interviewed residents R2-R3. Resident R2 and R3 stated they have not had any issues regarding their personal property. R2 and R3 stated staff has not taken their property and used it for themselves or given it to other residents to use. R2 and R3 stated there hasn't been any instance where staff open their packages or mail without their permission.

On December 26, 2025, LPA Manuel Monter interviewed R1. R1 stated there are several things that have gone missing from the previous care home. R1 stated he/she had a package that was sent to the care home, wipes, that were opened by the care home. R1 stated when his/her family went to collect the packages, they were already open. R1 stated staff S1 took his/her property and used them for other residents. R1 stated he/she was also missing his/her medications as well. R1 stated he/she couldn’t remember which ones were missing.

On January 13, 2026, LPA Manuel Monter interviewed resident R1’s family member, referred to as FM2. FM2 stated he/she went to pick up R1’s things after R1 had moved to a different facility. FM2 stated when he/she went to pick up R1’s belongings he/she signed a form. FM2 stated he/she also asked for R1’s mail / packages and medications. FM2 stated because this event was a long time ago, he/she doesn’t remember. FM2 stated not all R1’s medications were given to him/her. FM2 stated he/she doesn’t know which medications were missing. Page 5 Out of 6.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 26-AS-20250905090049

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: SWEET DREAMS CARE HOME LLC	FACILITY NUMBER: 435294351
	VISIT DATE: 01/14/2026

NARRATIVE

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FM2 stated he/she was informed by FM that R1 bought cleaning wipes thru amazon. FM2 stated he/she requested that amazon box. FM2 stated he/she was given an open box, and the cleaning wipes container was already opened. FM2 stated it was clearly used. FM2 stated he/she spoke to a staff member but doesn’t remember which staff he/she spoke to or what the conversation entailed.

The Department reviewed a letter from R1’s Family member (FM), dated August 27, 2025. The letter states that he/she almost picked up most of R1’s items. The letter states that there are still additional items that need to be picked up: hospital bed, air mattress, oxygen tank, lift, power wheel chair, outdoor ramp, and medical supplies.

The Department reviewed R1’s RCFE Medication Release form dated September 5, 2025. Based on a review, 7 medications were released, and the form was signed by R1’s Family member FM2.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

Page 6 Out of 6. END OF REPORT.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 6