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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380503052
Report Date: 03/10/2026
Date Signed: 03/10/2026 03:35:30 PM

Substantiated


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
02/28/2026 and conducted by Evaluator Yi Sam Jian
COMPLAINT CONTROL NUMBER: 14-AS-20260228164120
FACILITY NAME:BERNADETTE SMITH'S BOARD & CARE HOME #2FACILITY NUMBER:
380503052
ADMINISTRATOR:SMITH, BERNADETTEFACILITY TYPE:
735
ADDRESS:1648 REVERE STREETTELEPHONE:
(415) 822-6640
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:6CENSUS: 3DATE:
03/10/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Wayne SmithTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not ensure that facility is free of pests.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/10/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced 10-day complaint visit. LPA met with staff, Wayne Smith, LPA explained the purpose of the visit. During the visit, LPA discussed the allegation with staff and conducted a tour of the facility. The facility had previously been cited for pest-related conditions during a Case Management inspection conducted on 02/18/2026.

Based on the information obtained during the investigation, including documentation from local government agencies, The Department determined that the preponderance of evidence standard has been met, therefore the allegations above are found to be SUBSTANTIATED. A violation related to pest control was previously cited during a case management visit conducted on 02/18/2026, and the matter continues to be addressed through the ongoing case management process. As the violation has already been cited, no additional citation is being issued at this time.The report was reviewed with staff, and a copy was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Yi Sam Jian
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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