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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601127
Report Date: 02/18/2026
Date Signed: 02/18/2026 02:01:56 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
12/03/2025 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251203122307
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: 60DATE:
02/18/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Community Support Nurse, Shannon MetcalfeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not properly maintain the residents rooms
INVESTIGATION FINDINGS:
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On February 18, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Community Support Nurse, Shannon Metcalfe and explained the purpose of the visit.

Regarding the allegation, staff did not properly maintain the residents room, according to the reporting party, Resident 1's (R1's) room reeked of urine and the floor was dirty and Resident 2's (R2's) bedroom floor is dirty and sticky.

During a complaint visit conducted on 12/12/25, LPA observed R1 and R2's room. Although, R2's room was observed to be clean and odor-free, LPA observed R1's room to have a urine odor.

Based on observations made, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiency of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiency may result in civil penalties. Report is reviewed with Community Support Nurse 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: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
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 5
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
12/03/2025 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251203122307

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: 60DATE:
02/18/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Community Support Nurse, Shannon MetcalfeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff do not meet the residents bathing needs
Staff do not ensure a resident is being properly fed
Staff do not meet a resident's planned activity
Staff did not afford the residents privacy
INVESTIGATION FINDINGS:
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On February 18, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Community Support Nurse, Shannon Metcalfe and explained the purpose of the visit.

Regarding the allegation, staff do not meet the residents bathing needs, according to the reporting party, R2 is not showered regularly and Resident 3 (R3) is missing showers due to lack of staffing.

During the visit, LPA interviewed R2 and R3, reviewed service plans and shower logs provided by the facility. Based on R2 and R3's service plan, R2 receives showers once a week and R3 receives showers twice a week. LPA reviewed shower logs for both R2 and R3 which showed that both residents are receiving their showers as required based on their care plan. According to staff interviewed, there has not been any issues or complaints regarding R2 and R3 missing showers. Staff indicated, residents receive their showers as accorded to on their service plans unless residents refuse, however staff keep a shower refusal log. (Continue to 9099C).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
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 5
Control Number 14-AS-20251203122307
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: 02/18/2026
NARRATIVE
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Regarding the allegation, staff do not ensure a resident is being properly fed, according to the reporting party, staff do not get R2 up for breakfast.

During the investigation, LPA interviewed R2 and interviewed staff. According to staff interviewed, there are a couple residents who wake up later than other residents or prefer to have meals in their rooms. If residents don't come down to the dining hall for their meals, caregivers will go check in on the resident and ask if they want their meal delivered to their rooms. According to the previous Cullinary Director, the kitchen has a meal attendance tracking form that helps kitchen staff keep track of residents who have received their meals and residents who have not received their meals. If residents do not come down to the dining hall for the meals, the kitchen staff will notify the caregivers and the caregivers will go check on the resident.

Regarding the allegation, staff do not meet a resident's planned activity, according to the reporting party, there is no one at in the facility that will help her walk daily.

During the investigation, LPA observed and reviewed the activities calendar for the month posted on the first floor hallway and interviewed staff. According to staff interviewed, activities are provided to residents everyday and residents have a say on what goes on the activity calendar, however the facility can't accommodate one resident and what they want because there are other residents in the facility. LPA observed the activities calendar to have "walking for fitness" at least 3-4x a week. According to the activities director, walks are either inside the facility or outside the facility, depending on the weather and if the residents want to walk outside or inside. The activities director indicated, there are 3-4 residents who like to walk outside everyday and tries her best to take them on walks.

Regarding the allegation, staff did not afford the residents privacy, according to the reporting party, Resident 4 (R4) stated that staff talk to him/her about being sexually inappropriate. In addition, the reporting party indicated caregivers enter residents rooms without knocking and would linger when there are visitors visiting residents in their room.

During the visit, LPA interviewed residents and staff. According to R4, he/she does not remember saying or having sexual conversations with staff. According to R4, at times he/she can have memory issues but would remember if staff were having inappropriate conversations with him/her. According to staff and residents interviewed, staff are required to knock and wait for residents response prior (continue to 9099C)
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 14-AS-20251203122307
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: 02/18/2026
NARRATIVE
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to entering a residents room. According to the residents interviewed, staff always knock on their doors before entering. If there are visitors in the resident's room, staff ask if they are allowed to stay and do what is need or if they should come back when the visitors are gone.

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 Community Support Nurse and a copy is provided with appeal rights.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 14-AS-20251203122307
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: 02/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2026
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times...

This requirement is not met as evidenced by:
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Licensee/administrator shall submit a plan in writing on how to ensure resident rooms are clean and odor-free. Plan shall include, increasing housekeeping services.
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Based on LPA's observations, R1's room to have a urine odor which poses a potential health and safety risk to residents in care.
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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: 02/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5