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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600432
Report Date: 07/24/2025
Date Signed: 07/24/2025 11:15:21 AM

Unsubstantiated


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
06/11/2025 and conducted by Evaluator Yi Sam Jian
COMPLAINT CONTROL NUMBER: 14-AS-20250611094444
FACILITY NAME:PSALM RESIDENTIAL CARE HOMEFACILITY NUMBER:
385600432
ADMINISTRATOR:ANNA VILLANUEVA-AOAYFACILITY TYPE:
740
ADDRESS:565 GROVE STTELEPHONE:
(415) 621-8505
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:22CENSUS: 16DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Anna Villanuva-AoayTIME COMPLETED:
11:32 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not ensuring there is one working shower for every ten persons
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/24/2025, Licensed Program Analyst (LPA) Yi Sam Jian and Dominic Tobola arrived at the facility to deliver conclusionary finding for this complaint received by the Department. LPA was greeted by administrator, Anna Villanuva-Aoay, and explained the purpose of the visit.

Regarding the allegation that licensee is not ensuring there is one working shower for every ten persons. The Department has investigated the above allegation. Based on observations and interviews, the facility has three bathrooms with showering capacity, but only two are functional, serving 16 residents and three staff members. Based upon interivews with staff and residents, there is contradicting information received.The allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Report is reviewed with administrator and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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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