Senior Care Records.

Facility Evaluation Report

Partners for Independence- Inclusion CTR., Burlingame10/15/2025Licence 419210013

Capacity60
Census34
Date signed10/15/2025 02:15:07 PM
Name of licensing program analystMurial Han
Name of licensing program managerApril Cowan
The inspector’s account

On 10/15/2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to follow up on an incident that was reported by the facility. LPA met with Licensees, Adam Canon and Matthew Haake- Canon and administrator, Renz Corrales and LPA explained the purpose of the visit.

On 10/14/2025, facility reported that resident #1 (R1) slapped staff #1 (S1) resulting in S1 pushing R1 against the wall and placed his/her hand on R1's neck. This incident was witnessed by Staff #2 (S2) and Staff #3 (S3). After the incident, S1 was sent home and placed on administrative leave. After the incident, R1 was assessed and there was no injuries noted. The facility reported it to the local police department, R1's responsible party, GGRC and R1's residence.

During today's visit, LPA interviewed R1 who remembered partially of the incident but was not able to verbalize the details due to R1's diagnosis. R1 physically demonstrated a slap motion with his/her hand but was not able to provide additional details.

During today's visit, LPA interviewed S2 and S3 and both of them reported that the incident happened in the conference room.

S2 stated that he/she did not see R1 slapped S1 as he/she was entering the conference room but witnessed S1 pinned R1 against the wall and his/her hand was on R1's neck. Subsequently, S1 told S2 that R1 had slapped him/her.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction