415601127-1-27-2026-14-AS-ACON-DR2V6X-20260206151015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601127
Report Date: 01/27/2026
Date Signed: 01/27/2026 01:32:12 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
01/09/2026 and conducted by Evaluator Komal Curley

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20260109164112

FACILITY NAME:	SERRA HIGHLANDS SENIOR LIVING		FACILITY NUMBER:	415601127
ADMINISTRATOR:	SHAYAN GHEISAR		FACILITY TYPE:	740
ADDRESS:	501 KING DRIVE		TELEPHONE:	(650) 878-5111
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	120	CENSUS: 56	DATE:	01/27/2026
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Regional Sales, Ruth Ocon		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff use profanity towards resident.

INVESTIGATION FINDINGS:

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On January 27, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Regional Sales, Ruth Ocon and explained the purpose of the visit.

Regarding the allegation, staff use profanity towards resident, according to the reporting party, Staff 1 (S1) cursed at Resident 1 (R1).

During the investigation, LPA interviewed R1, staff and attempted to interview S1. According to R1, S1 says the F word or use other profanity towards him/her several times. LPA reached out to S1, however was unable to interview S1. According to staff interviewed, he/she witnessed S1 cursing at R1.

Based on information collected and file reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found 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 is reviewed with Regional Sales and a copy is provided with appeal rights.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

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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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
01/09/2026 and conducted by Evaluator Komal Curley

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20260109164112

FACILITY NAME:	SERRA HIGHLANDS SENIOR LIVING		FACILITY NUMBER:	415601127
ADMINISTRATOR:	SHAYAN GHEISAR		FACILITY TYPE:	740
ADDRESS:	501 KING DRIVE		TELEPHONE:	(650) 878-5111
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	120	CENSUS: 56	DATE:	01/27/2026
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Regional Sales, Ruth Ocon		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff does not respond to call button in a timely manner.
Staff does not assist resident.
Staff not providing a comfortable room temperature for resident(s).

INVESTIGATION FINDINGS:

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On January 27, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Regional Sales, Ruth Ocon and explained the purpose of the visit.

Regarding the allegation, staff does not respond to call button in a timely manner, according to the reporting party, when Resident 1 (R1) calls for assistance, it takes caregivers a long time to arrive.

During the investigation, LPA was unable prove or disprove this allegation as it appears based on staff and resident interviews, although response times vary due to overrall resident needs, staff do respond to the call button requests.

Regarding the allegation, staff does not assist resident, according to the reporting party, when R1 calls for assistance using his/her call button, Staff 2 (S2) would come turn off the call button and not assist R1. (continue to 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 14-AS-20260109164112

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: SERRA HIGHLANDS SENIOR LIVING	FACILITY NUMBER: 415601127
	VISIT DATE: 01/27/2026

NARRATIVE

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During the investigation, LPA interviewed R1, interviewed S2 and reviewed S2's personnel file. According to R1, when he/she pressed his/her call button, S2 came to R1 and turned the call button off and leave.S2 indicated that he/she has never turned off any residents call button and does not assist residents with care as that is not his/her job and is not trained for it. According to S2, he/she does not have access to the call button system nor does he/she keep a radio in their office. Based on S2's personnel record, LPA confirmed that S2 does not have any caregiving training.

Regarding the allegation, staff not providing a comfortable room temperature for resident(s), according to the reporting party, there are some areas in the facility that are cold and staff are not providing a comfortable room temperature.

During the investigation, LPA toured the facility with the maintenance director. A comfortable temperature of 69-72 degrees F is maintained throughout the facility and LPA observed thermostats to be in good working condition. In addition, the maintenance director indicated that most residents have portable space heaters in their rooms.

Based on documents reviewed, information collected, and interviews conducted, the department has determined that although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED.

Report is reviewed with Regional Sales, Ruth Ocon and a copy is provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

LIC9099 (FAS) - (06/04)

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Control Number 14-AS-20260109164112

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: SERRA HIGHLANDS SENIOR LIVING	FACILITY NUMBER: 415601127
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/03/2026 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 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: (1) To be accorded dignity in their personal relationships with staff... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/administrator shall conduct an in-service training regarding personal rights of residents, including but not limited to treating residents with dignity and respect
	8 9 10 11 12 13 14	Based on interviews, R1 indicated that S1 says the F word or use other profanity towards him/her several times. According to staff interviewed, he/she witnessed S1 cursing at R1 while assisting S1 with providing care to R1 which poses a potential health and safety risk to residents in care.	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: Komal Curley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

LIC9099 (FAS) - (06/04)

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