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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385601084
Report Date: 03/19/2025
Date Signed: 06/05/2025 09:34:25 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
11/13/2024 and conducted by Evaluator Yi Sam Jian
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241113155247
FACILITY NAME:LYNNE & ROY M FRANK RESIDENCESFACILITY NUMBER:
385601084
ADMINISTRATOR:TANG, EDWINAFACILITY TYPE:
740
ADDRESS:ONE AVALON AVENUETELEPHONE:
(415) 562-2855
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:220CENSUS: 163DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Robert Saison - Administrator and Gloria Vo - director of memory careTIME COMPLETED:
11:15 PM
ALLEGATION(S):
1
2
3
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5
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8
9
- Due to Lack of Care and Supervision Resident sustained pressure injuries
- Reporting requirement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS IS AN AMENDED REPORT FROM AN ORIGINAL REPORT DATED 03/19/2025. REPORT AMENDED TO CHANGE FINDINGS. On 06/05/2025, Licensed Program Analyst (LPA) Yi Sam Jian arrived at the facility to deliver an amended copy of LIC9099. LPA met with administrator Gloria Vo - Assistant Executive Director and explained the purpose of the visit.

Regarding the allegations of resident sustained pressure injuries due to Lack of Care and Supervision and reporting requirement. The facility provided documentation demonstrating the care and supervision provided to the resident, along with records of communication with the reporting party regarding the resident’s condition. Although the allegations may have happened or is 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. This report was reviewed with the Assistant Executive Director and a copy of the report left at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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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