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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201136
Report Date: 12/04/2025
Date Signed: 12/04/2025 10:41:00 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20251124131141
FACILITY NAME:PACALDO-YEEFACILITY NUMBER:
019201136
ADMINISTRATOR:PACALDO, JULIETFACILITY TYPE:
740
ADDRESS:999 TORRANO AVETELEPHONE:
(650) 393-0265
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY:14CENSUS: 10DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jason Salvador, Care StaffTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide a refund to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/4/2025 at 8:45 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 10 day initial complaint and deliver for the above allegations and met with care staff, Jason Salvador, Administrator (ADM) Dina Ramos was informed via phone regarding the purpose of the visit. ADM was not available during the time of the visit and gave permission to the care staff to sign the report.
Allegation: Staff did not provide a refund to the resident- Unfounded

During the course of the investigation, LPA confirmed that with S1, R1 resided at the facility after the change of ownership in July of 2025. R1 sided at the facility in the month of October 2025 – November 2025. This complaint finding is unfounded at this facility; however, it will be generated under the correct facility.

LPA has determined through staff interviews, documentation, and residents' LIC 604A that allegations are UNFOUNDED under this facility. A finding that is unfounded means the allegation is false, could not have happened, or is without a reasonable basis.

An exit interview is conducted a copy of this report is provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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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