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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701864
Report Date: 05/07/2021
Date Signed: 05/07/2021 01:34:45 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2020 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20200504151125
FACILITY NAME:LYTTON GARDENS COMMUNITY CAREFACILITY NUMBER:
430701864
ADMINISTRATOR:DORIS LEEFACILITY TYPE:
740
ADDRESS:649 UNIVERSITY AVENUETELEPHONE:
(650) 617-7338
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:55CENSUS: 39DATE:
05/07/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Doris LeeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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-Staff called the resident inappropriate names
-Staff threatened resident
-Staff made inappropriate comments towards resident
INVESTIGATION FINDINGS:
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On 5/7/2021 Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced complaint investigation regarding the above allegations. LPA met with Administrator Doris Lee via tele-visit due to Covid-19 procedures and explained the purpose of the tele-visit.

Regarding the allegation of Staff called the resident inappropriate names, the Department investigation found the following: LPA Marrufo conducted the initial investigation, and then it was reassigned to LPA Hopkins. LPA Hopkins interviewed staff and residents, staff stated that they have never called any residents inappropriate names and have never heard of any other staff calling residents inappropriate names. Residents interviewed stated that they never have been called inappropriate names by staff members or have heard of any other residents being called inappropriate names.

Report Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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 2
Control Number 26-AS-20200504151125
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: LYTTON GARDENS COMMUNITY CARE
FACILITY NUMBER: 430701864
VISIT DATE: 05/07/2021
NARRATIVE
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Regarding the allegation of Staff threatened resident, the Department investigation found the following: during interviews with staff and residents, both parties stated there have never been any threats made by staff to residents.

Regarding the allegation of Staff made inappropriate comments towards resident, the Department investigation found the following: during interviews with staff and residents, staff stated that they never made any inappropriate comments nor did they hear any other staff make inappropriate comments. Resident stated that they have never heard staff make any inappropriate comments towards other residents.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Doris Lee. A copy of this report was provided to Doris Lee via email, due to COVID-19 precautionary measures, with a "read receipt" to verify the LIC9099 and 9099-C was received. Doris Lee can print out the report and fax a signed copy to LPA at 650-266-8841 or email to LPA at Christopher.Hopkins-Clarke@dss.ca.gov.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
LIC9099 (FAS) - (06/04)
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