430701864-3-5-2026-26-AS-ACON-DTTL8H-20260506083154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430701864
Report Date: 03/05/2026
Date Signed: 03/05/2026 03:00:04 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2025 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20251028111726

FACILITY NAME:	LYTTON GARDENS COMMUNITY CARE		FACILITY NUMBER:	430701864
ADMINISTRATOR:	ANAHI MCKANE		FACILITY TYPE:	740
ADDRESS:	649 UNIVERSITY AVENUE		TELEPHONE:	(650) 617-7338
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94301
CAPACITY:	55	CENSUS: 41	DATE:	03/05/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Anahi McKane		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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- Residents needs are not being met

INVESTIGATION FINDINGS:

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LPA Jeung met with administrator and obtained information about this RCFE and the adjacent buildings, which are operated by the same owner: there is a skilled nursing facility--licensed by CA Dept. of Health Services--independent HUD housing--which is not licensed by the state--a continuing care retirement community (CCRC)--licensed by the CA Dept. of Social Services. This licensed RCFE comprises units on the ground floor and 2nd floor only. The emergency call system covers the building that houses the RCFE as well as the independent units at 656 Lytton Avenue, where LPA observed the monitor at the reception desk. When a resident activates the call alarm, the room of origin and the time appears on the computer monitor and assisted living pager, which is carried by staff on duty 24 hours/day. In the bathroom of each assisted living apartment, there is a wall mounted Arial call station that is activated by pulling the string cord or pushing the big blue button. A portable pendant alarm and chain are issued to residents, as well, which can be worn around the neck. According to administrator, staff are expected to respond to residents' calls within 3 minutes.
Continued on next page

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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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Control Number 26-AS-20251028111726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: LYTTON GARDENS COMMUNITY CARE	FACILITY NUMBER: 430701864
	VISIT DATE: 03/05/2026

NARRATIVE

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LPA reviewed the Arial device activity reports for September and October 2025, which included the times that the devices were activated, from which room, and when staff responded. LPA identified residents who experienced response times over 20 minutes, according to the reports. Nine residents were interviewed about the response times when they activated their Arial call system, and at least 3 recalled waiting a long time for staff to come to assist them.

Based on information obtained from facility staff and residents, this allegation is substantiated. The preponderance of evidence standard has been met.

Deficiency of the California Code of Regulations, Title 22 is cited on a following page.

SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2025 and conducted by Evaluator Audrey Jeung

COMPLAINT CONTROL NUMBER: 26-AS-20251028111726

FACILITY NAME:	LYTTON GARDENS COMMUNITY CARE		FACILITY NUMBER:	430701864
ADMINISTRATOR:	ANAHI MCKANE		FACILITY TYPE:	740
ADDRESS:	649 UNIVERSITY AVENUE		TELEPHONE:	(650) 617-7338
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94301
CAPACITY:	55	CENSUS: 41	DATE:	03/05/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Anahi McKane		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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- Insufficient staffing

INVESTIGATION FINDINGS:

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LPA Jeung met with administrator and obtained information about this RCFE and the adjacent buildings, which are operated by the same owner: there is a skilled nursing facility--licensed by CA Dept. of Health Services--independent HUD housing--which is not licensed by the state--a continuing care retirement community (CCRC)--licensed by the CA Dept. of Social Services. This licensed RCFE comprises units on the ground floor and 2nd floor only. There are 2 caregivers scheduled morning and evening shifts from 7 am to 11 pm to provide care to residents with some personal care--including showers--and supervision. In addition, there is a med tech who works until 2:30 pm and a licensed vocational nurse who works from 12:30 pm until 9 pm. Facility does not provide care to those needing assistance with transfers, toiletting, feeding and those diagnosed with dementia.

Based on interviews with staff and residents, this allegation is determined to be unsubstantiated. There is not enough evidence to prove the alleged violation did or did not occur, although the allegation may have occurred or is valid,

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20251028111726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: LYTTON GARDENS COMMUNITY CARE	FACILITY NUMBER: 430701864
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/05/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/19/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	PERSONNEL REQUIREMENTS Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met, as significant delayed response times were experienced by residents in September and	1 2 3 4 5 6 7	Plan of correction to be sent to CCLD BY DUE DATE
	8 9 10 11 12 13 14	Ocober 2025 when they activated the emergency signal system in their rooms. This is reflected on facility's device activity reports, and verified by residents. Licensee failed to ensure timely response times when residents called for staff assistance, which posed a potential health, safety or personal rights risk.	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: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

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