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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202647
Report Date: 07/30/2026
Date Signed: 07/30/2026 11:23:21 AM

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
07/22/2026 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20260722095609
FACILITY NAME:PARKSIDE VILLA INCFACILITY NUMBER:
435202647
ADMINISTRATOR:FORONDA-CAYABYAB, MARIEFACILITY TYPE:
740
ADDRESS:300 S 22ND STTELEPHONE:
(408) 831-7411
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:15CENSUS: 15DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Ninfa Gozon and Lady Sheenely AngelesTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Staff do not provide adequate supervision, resulting in residents leaving the facility unsupervised
Staff did not respond to injured resident calling for help
Staff is having residents perform personal services for him
INVESTIGATION FINDINGS:
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On 07/30/2026 Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannouced complaint investigation and met with the facility designated administrator(DA) Ninfa Gozon and lead staff (LS) Lady Sheenely Angeles. LPA stated the purpose of the visit is to address a complaint received by the department on 07/22/2026.

During today's 07/30/2026, LPA Partoza conducted an inspection and interview of 2 staff and found that the resident addressed in the complaint does not reside at the facility. The complaint will be redirected to the right facility where the individual resides. Cross reference complaint #26-AS-20260730094306. This department has investigated the complaint with the above allegations and found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies are cited during today's visit. An exit interview was conducted with Designated Administrator (DA) Ninfa Gozon and Lead Staff (LS) Lady Sheenely Angeles and a copy of the report was provied.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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