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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600382
Report Date: 04/02/2026
Date Signed: 04/02/2026 01:54:16 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
02/24/2026 and conducted by Evaluator Yi Sam Jian
COMPLAINT CONTROL NUMBER: 14-AS-20260224064215
FACILITY NAME:CARE AND CARE RESIDENCE IIFACILITY NUMBER:
385600382
ADMINISTRATOR:NEVAREZ, JOSEFACILITY TYPE:
740
ADDRESS:901 GRAFTON AVENUETELEPHONE:
(415) 715-8400
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:6CENSUS: 5DATE:
04/02/2026
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Michelle PerezTIME COMPLETED:
02:13 PM
ALLEGATION(S):
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-Facility staff are not properly addressing bed bugs in the facility
INVESTIGATION FINDINGS:
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On 04/02/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced complaint investigation visit. LPA met with Michelle Perez, Caregiver. LPA explained the purpose of the visit.

During the visit, resident R2 directed the LPA to a bed where the LPA observed a live bed bug crawling, confirming the presence of a bed bug on the resident’s bed. Administrator denied having a bed bug issue. Based on LPA observation, interviews and file reviews during the course of the investigation it was determined that the preponderance of evidence standard has been met, therefore the allegations above are found to be SUBSTANTIATED.

The deficiency is cited in accordance with California Code of Regulations, Title 22 Division 6, Chapter 8 and is noted on the attached LIC 9099-D. Report was reviewed with caregiver. A copy of this report and Appeal Rights was provided to facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
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 14-AS-20260224064215
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CARE AND CARE RESIDENCE II
FACILITY NUMBER: 385600382
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2026
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation..(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by:
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The licensee shall develop a plan to ensure the facility is cleaned, safe and sanitary to all residents. The plan shall have a different intervention as the current plan is not working. The licensee will submit a copy of the plan to CCL by POC due date.
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Based on observation, record review and interview, facility has bedbugs which poses an immediate health and safety risks to residents in care.
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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: Brenda Chan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2