Complaint Investigation Report

410508866-3-2-2026-14-AS-BCHN-DTDTLF-20260422144924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BRUNO RO , 851 TRAEGER AVE., SUITE 360

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/17/2025 and conducted by Evaluator Grace Donato

COMPLAINT CONTROL NUMBER: 14-AS-20251117151146

On 3/2/2026, Licensing Program Analyst (LPA) Grace Donato arrived at the facility to deliver conclusionary findings for this complaint received on November 17, 2025. LPA Donato was greeted by Administrator Elissa Jones and explained the purpose of the visit.

Complaint alleged that facility is unkempt. According to the reporting party, the facility uses dog pee pads as table cloths in the dining room and R1’s bedroom and a malodorous smell was observed. During LPA Calandra’s initial visit on 11/19/2025, LPA observed that the facility was using diapers as placemats in the dining room and a wet/used diaper was observed on R1’s bed.

Based on the LPA’S observations, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D.

Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties.

An exit interview was conducted and a copy of the report along with Appeal Rights were provided.