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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601141
Report Date: 02/19/2025
Date Signed: 02/19/2025 03:17:19 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
01/29/2025 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250129105003
FACILITY NAME:SANDHILL ASSISTED LIVING LLCFACILITY NUMBER:
415601141
ADMINISTRATOR:TILMA, SUSANFACILITY TYPE:
740
ADDRESS:1239 MIDDLE AVETELEPHONE:
(650) 796-9921
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:6CENSUS: 5DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Susan TilmaTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Licensee is not ensuring that the facility has sufficient staff to meet the needs of residents in care.
Licensee did not ensure that resident received medical attention in a timely manner.
INVESTIGATION FINDINGS:
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On 2/19/2025 Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit at the facility. LPA met with Administrator Susan Tilma and explained the purpose of the visit.

Regarding the allegation of Licensee is not ensuring that the facility has sufficient staff to meet the needs of residents in care, reporting party (RP) stated that one of the residents (R1) reported to RP that there is a staffing problem at the home. R1 had to wait a really long time to get help particularly in the morning. R1 said it has been going on for months.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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
Control Number 14-AS-20250129105003
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: SANDHILL ASSISTED LIVING LLC
FACILITY NUMBER: 415601141
VISIT DATE: 02/19/2025
NARRATIVE
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LPA Donato interviewed a staff member. S1 shared that they are often working with alone with 5-6 residents and that they have been in a situation where a resident was slipping to the floor from the chair and was unable to pick the resident up but because S1 was working alone. The staff have difficulty addressing the other resident’s needs, for example, if a resident needs their help to walk to the bathroom but they cannot get to them in time and they soil themselves.

LPA interviewed R1. It was shared that most of the time he/she had to wait to be assisted in the morning. R1 mentioned that it was already brought up, but nothing has changed. R2 & R3 were also interviewed and said that staffing is ok. They are being helped if needed. However, these two residents are able to ambulate with minimal assistance.

LPA also observed that there is only one staff scheduled from 7-9am preparing breakfast and then starting with morning care for 5 residents. LPA also observed that S1s back was wet with urine when being assisted by a staff that started at 9am. S1 was soaked with no timeline as to when it started.

LPA also obtained photos of R1 soaked in urine because staff was not able to change R1 on time.

Regarding the allegation of Licensee did not ensure that resident received medical attention in a timely manner, RP stated that a staff had texted the Licensee to let them know that one of the residents was complaining about burning upon urination. S1 tested the urine and it was positive for UTI. It took Licensee 2 days to get back with S1 and then asked to call the MD for an antibiotic prescription.

LPA interviewed R1 and it was confirmed that it took days before R1 was able to talk to the doctor. S2 also confirmed that it did took them 2 days to call the doctor.

Therefore, based on the interviews conducted and information collected, the above allegations are
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 is reviewed. A copy of the report and appeal rights are provided.

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SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 14-AS-20250129105003
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: SANDHILL ASSISTED LIVING LLC
FACILITY NUMBER: 415601141
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/20/2025
Section Cited
CCR
87465(a)(1)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
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Licensee to submit a plan addressing how residents medical needs will be addressed in a timely manner. Licensee to submit plan by POC due date.
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This was not met as evidenced by:
Based on interviews, R1 was not provided timely medical care due to Licensee took two days after UTI home test before R1 was able to talk to a physician, which poses an immediate health, safety, and personal rights risk to persons in care.
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Type A
02/26/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements – General (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents...
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On 4/10/25 LPA delivered a copy of amended LIC9099D.

Deficiency is cleared and corrected.
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This requirement was not met as evidenced by: Based on interviews, observations and records review, there was not enough staff member scheduled to cater to the resident’s care which poses an immediate health, safety, and personal rights risk to persons 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 Charitra
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
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