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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415202881
Report Date: 02/20/2026
Date Signed: 02/20/2026 02:28:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/12/2026 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20260212115650
FACILITY NAME:TELECARE POPLAR HOUSEFACILITY NUMBER:
415202881
ADMINISTRATOR:KYLEE LIDDLEFACILITY TYPE:
737
ADDRESS:2299 POPLAR AVETELEPHONE:
(650) 352-6588
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:4CENSUS: 3DATE:
02/20/2026
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Lead Staff, Christopher RazaTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Licensee does not ensure staff receive adequate training while providing care to clients
INVESTIGATION FINDINGS:
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On February 20, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced 10-day complaint visit. Upon entry, LPA met with co-lead staff, Licensed Vocational Nurse (LVN), and 2 caregivers and LPA explained the purpose of today's visit. The lead staff, Christopher Raza arrived momentarily and assisted with the complaint investigation.

During today's visit, LPA reviewed the allegation and interviewed facility staff members.

Regarding to allegation of - Licensee does not ensure staff receive adequate training while providing care to clients, the reporting party stated that they have not received CPI (Criss Prevention Intervention) refreshers except for an informal practice initiated by the administrator. The reporting party stated that although a CPI review was scheduled for 2/10/2026, the reporting party reported that it did not occur. The reporting party expressed concern that staff are required to demonstrate CPI techniques before calling emergency services, yet proper training has not been maintained.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
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 3
Control Number 26-AS-20260212115650
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: TELECARE POPLAR HOUSE
FACILITY NUMBER: 415202881
VISIT DATE: 02/20/2026
NARRATIVE
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As part of the investigation, LPA interviewed facility lead staff who stated that facility staff members have received the annual emergency intervention training (CPI). However, the monthly refreshers that were provided by the administrator were read and signed training session that did not include any hands-on techniques training.

LPA interviewed 3 facility staff and all of them reported that the monthly refresher training sessions that were provided by the administrator were pre-signed and pre-dated refresher training on paper; they were not trained on techniques to prevent injury to, and maintain safety for, clients and facility staff.

After the investigation, this allegation is substantiated as the administrator did not provide "Emergency intervention training" means the techniques that will be used to prevent injury to clients, consumers and others.

Based on interviews and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation was determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties.

Report was discussed with lead staff. A copy of the report and the appeal rights were provided.

SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 26-AS-20260212115650
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: TELECARE POPLAR HOUSE
FACILITY NUMBER: 415202881
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2026
Section Cited
CCR
89965(i)
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89965 Personnel Requirements(i) In addition to any other required training, each direct care staff person shall..emergency intervention training..the techniques the licensee will use to prevent injury and...

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The licensee will develop a plan of correction indicating the monthly emergency intervention training will include techniques that the licensee will use to prevent injury to, and maintain safety for consumers who are danger to themselves or others.
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This requirement has not met as evidenced by: based on interviews and staff interviews, the licensee did not ensure that the additional emergency intervention training provided by the administrator used techniques to prevent injury which posed a potential health and safety risk to residents in care.
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The licensee will provide a copy of the plan of correction to CCL by 3/6/2026.
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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: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3