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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410508725
Report Date: 12/15/2025
Date Signed: 12/15/2025 03:32:48 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
10/03/2025 and conducted by Evaluator Yi Sam Jian
COMPLAINT CONTROL NUMBER: 14-AS-20251003111926
FACILITY NAME:C AND Z RESIDENTIAL CAREFACILITY NUMBER:
410508725
ADMINISTRATOR:HERRERA, CESAR DE JESUSFACILITY TYPE:
735
ADDRESS:636 SOUTHMOOR DRIVETELEPHONE:
(650) 355-3317
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:0CENSUS: 0DATE:
12/15/2025
UNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Mayra HerreraTIME COMPLETED:
03:58 PM
ALLEGATION(S):
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- Licensee instructed a resident not to report a serious incident
-Staff did not allow residents to leave bedrooms for an entire day
-Staff did not allow residents to attend Day Program
- An uncleared adult residing at the facility
INVESTIGATION FINDINGS:
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On 12/15/2025 Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced complaint inspection to deliver findings regarding the complaint allegations received. LPA contacted over the telephone with licensee’s daughter, Mayra Herrera(S1), LPA explained the purpose of the visit.

The Department investigated the allegation that the Licensee instructed a resident not to report a serious incident. Court documents and interviews indicate that the Administrator knowingly concealed the presence of an individual with a criminal history who was living at the facility and participating in facility operations, despite not being associated with the facility.

The Department investigated an allegation that an uncleared adult was residing in the facility. The investigation determined that an uncleared and unapproved adult had access to and/or resided in a bedroom designated for residents, rather than staff use, which posed a significant health and safety risk to clients in care. CONT. TO 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 14-AS-20251003111926
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: C AND Z RESIDENTIAL CARE
FACILITY NUMBER: 410508725
VISIT DATE: 12/15/2025
NARRATIVE
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The Department investigated the allegation that Staff did not allow residents to leave bedrooms for an entire day. The presence of narcotics and law enforcement actions rendered the environment unsafe and restrictive. The licensee’s mismanagement and concealment of an unauthorized resident created conditions that limited residents’ freedom of movement and sense of security.

The Department investigated the allegation that Staff did not allow residents to attend Day Program. Due to the unsafe conditions arising from the unauthorized adult’s criminal activity and the police investigation, residents’ participation in community day programs was disrupted. The facility did not provide an environment conducive to consistent program attendance and community integration.

Based on the evidence obtained during the investigation, along with conflicting statements provided by the licensee, the Department determined that the preponderance of evidence standard has been met. Therefore, the above allegations are 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 is reviewed with S1, a copy of the report and appeal rights are emailed to S1.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 14-AS-20251003111926
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: C AND Z RESIDENTIAL CARE
FACILITY NUMBER: 410508725
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/16/2025
Section Cited
CCR
80019(e)
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80019(e) Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility. This regulation has not been met as evidenced by:
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The licensee forfeited their license and ceased operation of the facility.
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Based on the events that occurred on 09/30/2025, a male adult that did not receive a criminal record clearance prior to residing, working, or volunteering at the facility was found to be on facility property. This poses an immediate health and safety risk to residents in care. Civil penalty is issued as a result in the amount of $100. Further civil penalties may be assessed in the future pending the ongoing investigation.
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Type B
12/16/2025
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights (a)… each client shall have personal rights which include, …(2) To be accorded safe, healthful and comfortable accommodations
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The licensee forfeited their license and ceased operation of the facility.
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This regulation was not met, as interviews and law enforcement documentation indicate that the licensee’s mismanagement and concealment of an unauthorized resident restricted residents’ freedom of movement and sense of security, constituting a violation of personal rights and a potential health and safety risk to clients 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: 12/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 14-AS-20251003111926
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: C AND Z RESIDENTIAL CARE
FACILITY NUMBER: 410508725
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2025
Section Cited
CCR
80072(a)(6)
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80072 Personal Rights (a)… each client shall have personal rights which include, …(6) To leave or depart the facility at any time.
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The licensee forfeited their license and ceased operation of the facility.
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This regulation was not met, as interviews and law enforcement documentation indicate that the licensee’s mismanagement and concealment of an unauthorized resident restricted residents’ freedom of movement and sense of security, constituting a violation of personal rights and a potential health and safety risk to clients 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: 12/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5