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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601080
Report Date: 04/23/2026
Date Signed: 04/23/2026 02:35:37 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
03/11/2026 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20260311101613
FACILITY NAME:COGIR OF BELMONTFACILITY NUMBER:
415601080
ADMINISTRATOR:JIM SIDOTIFACILITY TYPE:
740
ADDRESS:900 SIXTH AVENUETELEPHONE:
(650) 591-2008
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:68CENSUS: 57DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Administrator, Jim SidotiTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff do not allow residents to visit at facility
INVESTIGATION FINDINGS:
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On April 23, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Administrator, Jim Sidoti and explained the purpose of the visit.

Regarding the allegation, staff do not allow residents to visit at facility, according to the reporting party, he/she wants to visit residents at the facility, however staff are not allowing him/her to do so. According to the reporting party, staff are telling the reporting party that he/she needs an invitation to visit residents at the facility and needs to give prior notification.

During the investigation, LPA reviewed the facility's visitation policy and conducted interviews. The facility's visitation policy on the residency agreement indicates, "All visitors must register at the front desk when entering Cogir of Belmont. We reserve the right to remove or deny entry to Cogir of Belmont to any visitor whom we determine is disruptive or dangerous." According to the interviews conducted, it does not seem like facility has a fixed policy in place for visitation as interviews conducted indicates that the policy is determined by individual receptionists. (Continue to 9099C).

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
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 3
Control Number 14-AS-20260311101613
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: COGIR OF BELMONT
FACILITY NUMBER: 415601080
VISIT DATE: 04/23/2026
NARRATIVE
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Furthermore, according to Staff 1 (S1), he/she had an interaction with the reporting party when the reporting party came to the facility to visit to current residents. S1 indicated he/she notified Staff 2 (S2) to let the residents know that the reporting party was at the facility to visit them, however according to S2, he/she indicated that he/she was never told to go check on the residents to see if they wanted the reporting party to visit. Nevertheless, the facility denied resident rights to visitors.

Based on interviews conducted and information collected during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation is determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties.

Report was discussed with Administrator, and Appeal Rights provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20260311101613
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: COGIR OF BELMONT
FACILITY NUMBER: 415601080
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2026
Section Cited
CCR
87468.1(a)(11)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (11) To have their visitors...permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.

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Licensee/administrator shall create a new visitation policy and provide a copy to CCLD and post a copy of the visitation policy at every facility entrance. Licensee/administrator to conduct an in-service training with staff regarding visitation policy and submit a copy of sign-in sheet to LPA by 4/30/26
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This requirement is not met as evidenced by: According to the interviews conducted, it does not seem like facility has a fixed policy in place for visitation as interviews conducted indicates that the policy is determined by individual receptionists. In addition, based on staff interviews, when R1 came to visit two residents at the facility, S1 indicated he/she notified S2 to let the residents know that the reporting party was at the facility to visit them, however according to S2, he/she indicated that he/she was never told to go check on the residents to see if they wanted the reporting party to visit.
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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: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3