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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410508402
Report Date: 04/16/2025
Date Signed: 04/16/2025 03:36:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2025 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250314092346
FACILITY NAME:B & B RESIDENTIAL FACILITIESFACILITY NUMBER:
410508402
ADMINISTRATOR:BULJAN, ANTE & SLAVAFACILITY TYPE:
740
ADDRESS:13 W. 38TH AVENUETELEPHONE:
(650) 570-5124
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:6CENSUS: 6DATE:
04/16/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrators Ante and Nediljka BuljanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Unqualified staff are administering medications to residents in care

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/16/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigaiton visit to deliver findings regarding the allegations received. LPA met with administrators Administrators Ante and Nediljka Buljan and explained the purpose of today's visit.

During the course of the investigation, LPA conducted interviews, conducted research, and reviewed pertinent documents related to the allegations. According to interviews, staff were trained by hospice to administer medication such as morphine, and administered it to a hospice resident at least once. Additionally staff were being requested by family to provide the morphine at least one time. Title 22 regulations do not allow staff to administer such medication to residents even if on hopsice. This allegation is substantiated.

Based on LPA interviews and items letters received, 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. Report is reviewed with Ante and a copy of this report is provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2025 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250314092346

FACILITY NAME:B & B RESIDENTIAL FACILITIESFACILITY NUMBER:
410508402
ADMINISTRATOR:BULJAN, ANTE & SLAVAFACILITY TYPE:
740
ADDRESS:13 W. 38TH AVENUETELEPHONE:
(650) 570-5124
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:6CENSUS: DATE:
04/16/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrators Ante and Slava BuljanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff did not provide adequate food service to resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/16/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigaiton visit to deliver findings regarding the allegations received. LPA met with administrators Ante and Slava Buljan and explained the purpose of today's visit.

During the course of the investigation, LPA conducted interviews, conducted research, and reviewed pertinent documents related to the allegations. According to interviews and documentation reviewed, the resident was provided food regularly daily for all meals. In regards to R2 not being provided adequate food service, it was mainly a verbal request by family and administrator to not overfeed R2 if they are not swallowing or still has food in their mouth. Food service was provided as scheduled per interviews. This allegation is unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 14-AS-20250314092346
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: B & B RESIDENTIAL FACILITIES
FACILITY NUMBER: 410508402
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/17/2025
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
87468.1(a)(2) - Personal Rights of Residents in All Facilities - (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This regulation has not been met as evidenced by:
1
2
3
4
5
6
7
Facility shall develop a plan to ensure how they will meet this regualtion in regards to medications such as morphine in the future. This plan shall be received by the department per the due date provided.
8
9
10
11
12
13
14
Based on inteviews conducted, the facility indicated that they were trained by hospice to provide morphine when needed. Additionally staff were being requested by family to provide the morphine at least one time. This poses an immediate health and safety risk to residents in care as the staff providing is not a skilled professional such as a nurse.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3