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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601165
Report Date: 11/07/2025
Date Signed: 11/07/2025 10:52:16 AM

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
10/29/2025 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251029145313
FACILITY NAME:GENERATIONS CARE HOMEFACILITY NUMBER:
415601165
ADMINISTRATOR:MEHTA, IRENEFACILITY TYPE:
740
ADDRESS:859 CAMARITAS CIRTELEPHONE:
(650) 438-6710
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:6CENSUS: 4DATE:
11/07/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Irene MehtaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not issue an appropriate refund to resident or resident's authorized representative
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Jeung met with administrator to discuss refund of pro-rated monthly fee for client #1, who moved out of facility on 4/8/25. LPA also reviewed client file and obtained copies of relevant documents, including proof of delivery of certified mail to son of client #1 on 9/20/25. Receipt of check has been acknowledged by client's daughter. However, the payee is client. Son/DPOA claims that it cannot be cashed and mailed the check back to facility. Administrator denies receiving the check.

Based on records reviewed and information from administrator, this allegation is determined to be unsubstantiated. Although the allegation may have occurred or is valid, there is not enough evidence to prove the alleged violation did or did not occur.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
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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