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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601127
Report Date: 12/04/2024
Date Signed: 12/04/2024 12:58:50 PM

Unsubstantiated


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
11/25/2024 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241125161351
FACILITY NAME:SERRA HIGHLANDS SENIOR LIVINGFACILITY NUMBER:
415601127
ADMINISTRATOR:SHAYAN GHEISARFACILITY TYPE:
740
ADDRESS:501 KING DRIVETELEPHONE:
(650) 878-5111
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:120CENSUS: 68DATE:
12/04/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Shayan GheisarTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Facility faucets used by residents for personal care do not deliver hot water
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
On December 4, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Administrator, Shayan Ghesiar and Business Office Manager, Natice Coles and explained the purpose of the visit.

Regarding the allegation, facility faucets used by residents for personal care do not deliver hot water, according to the reporting party, the facility has failed to provide adequate bathing shower water temperature above 86 degrees.

During the visit, LPA measured water temperature which includes faucets and showers in 5 resident rooms on the first floor and 5 resident rooms on the second floor. Water temperature throughout the facility measured between 105-107.2 degrees F.

Based on observations conducted, the department has determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed with Administrator and a copy is provided
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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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