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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600616
Report Date: 09/01/2026
Date Signed: 09/01/2026 01:41:14 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
08/24/2026 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20260824164148
FACILITY NAME:NEW CEDAR LANE CARE HOME, INC.FACILITY NUMBER:
415600616
ADMINISTRATOR:DIAZ, YOLANDAFACILITY TYPE:
740
ADDRESS:924 CEDAR STREETTELEPHONE:
(650) 728-3132
CITY:MONTARASTATE: CAZIP CODE:
94037
CAPACITY:23CENSUS: 14DATE:
09/01/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Care Coordinator, Nancy HernandezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility Staff will not allow visitors during reasonable hours
INVESTIGATION FINDINGS:
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On September 1, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannouced 10-day complaint visit. Upon entry, LPA met with care coordinator who contact the administrator/licensee over the phone and LPA explained the purpose of today's visit.

Regarding the allegation of- facility staff will not allow visitors during reasonable hours, the reporting party stated that resident #1 (R1)’s family is not allowed to visit during reasonable hours. In addition, the reporting party stated that the administrator of the facility stated to a family member that they were not allowed to visit R1 unless it was on Monday – Friday as the administrator has to be there for all visits.

During today’s visit, LPA toured the facility, interviewed R1, and the administrator.

LPA interviewed R1 who appeared with bright affect, pleasant, and stated that he/she liked the facility and he/she has 2 kids but R1 could not answer additional questions.



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
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 14-AS-20260824164148
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: NEW CEDAR LANE CARE HOME, INC.
FACILITY NUMBER: 415600616
VISIT DATE: 09/01/2026
NARRATIVE
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LPA interviewed the administrator who acknowledged that she put some restrictions to R1's visits from a family member such as only visits on Monday- Friday and not on the weekends because there were safety concerns that was brought to her attention regarding some family members so to ensure everyone's safety, she placed the restrictions.

After the investigation, this allegation is deemed to be substantiated as the resident has the right to their visitors as part of their rights and according to R1's admission agreement as it indicated that the facility visiting hours are 10 am- 7pm and family and friends are encouraged to visit during visiting hours.

Based on interviews and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegations were 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.

This report is reviewed and discussed with the care coordinator and the administrator/licensee

A copy of the report and appeal rights were provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20260824164148
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: NEW CEDAR LANE CARE HOME, INC.
FACILITY NUMBER: 415600616
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2026
Section Cited
CCR
87468.1(a)(11)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities.. shall have all of the following personal rights: This requirement is not met as evidenced
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The administrator/licensee will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 9/9/2026.
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by the facility informed one of R1's family member that visits are on Monday- Friday and not on the weekends which poses a potential 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.
SUPERVISOR'S NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3