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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601080
Report Date: 03/18/2025
Date Signed: 03/18/2025 12:55:28 PM

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
03/07/2025 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250307083648
FACILITY NAME:VISTA TERRACE OF BELMONTFACILITY NUMBER:
415601080
ADMINISTRATOR:KAITLYN CLAREYFACILITY TYPE:
740
ADDRESS:900 SIXTH AVENUETELEPHONE:
(650) 591-2008
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:68CENSUS: 36DATE:
03/18/2025
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Administrator, Kaitlyn ClareyTIME COMPLETED:
01:06 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not intervene in verbal altercation between residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On March 18, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver findings for the above allegation. LPA met with Administrator, Kaitlyn Clarey and explained the purpose of the visit.

Regarding the allegation, facility staff did not intervene in verbal altercation between residents, according to the reporting party, on March 6, 2025, it was observed Resident 1 (R1) and Resident 2 (R2) had a verbal altercation outside the dining room after a town hall meeting. Reporting party indicated, there were about 8-10 staff members present but they did not take action or step in.

During the investigation, LPA interviewed administrator, reviewed staff schedule and interviewed staff. According to the administrator, there were 9 staff members on the schedule the day of the town hall meeting but none of them witnessed the altercation. The administrator indicated, she was also at the building during the town hall meeting but did not observe the altercation. LPA reviewed the staff schedule and observed 9 staff members on schedule on 3/6/25 during the town hall meeting. LPA interviewed 9/9 of the staff members present on shift during the residents' town hall meeting and they indicated that they did not observe the altercation between R1 and R2.

Based on interviews conducted, the department has determined that although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations 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: Komal Charitra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
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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