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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202415
Report Date: 04/16/2021
Date Signed: 04/16/2021 11:51:42 AM

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
11/14/2019 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20191114130648
FACILITY NAME:CASA ALICE CARE HOMEFACILITY NUMBER:
435202415
ADMINISTRATOR:PING JING ZHAOFACILITY TYPE:
740
ADDRESS:809 ALICE AVENUETELEPHONE:
(650) 279-7488
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:6CENSUS: 6DATE:
04/16/2021
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Becky BiTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
-Facility staff illegally evicted resident
-Facility staff is not sufficient to meet resident's needs
-Facility staff disclosed resident's private information
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/16/2021 Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced complaint investigation regarding the above allegation. LPA met with Administrator Becky Bi via tele-visit due to Covid-19 procedures and explained the purpose of the tele-visit.

Regarding the allegations above, LPA David Marrufo conducted the investigation, and based on interviews with Administrator, Licensee, and staff it appeared to be a misunderstanding about the eviction of the resident. The resident never received an eviction notice. Licensee and Administrator suggested the resident be moved to where the responsible party wanted him/her, due to the responsible party stating they were looking for another care home. Too much time has lapsed regarding the rest of the allegations, therefore the Department does not have enough evidence.

Although the 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 allegations are UNSUBSTANTIATED.

An exit interview was conducted. Report was discussed with and emailed to Administrator Becky Bi for signature.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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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