<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601112
Report Date: 08/26/2025
Date Signed: 08/26/2025 03:40:51 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
06/16/2025 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250616144837
FACILITY NAME:MILLBRAE ASSISTED LIVING HOMEFACILITY NUMBER:
415601112
ADMINISTRATOR:PO, GINGERFACILITY TYPE:
740
ADDRESS:1001 HEMLOCK AVETELEPHONE:
(650) 689-5776
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:48CENSUS: 45DATE:
08/26/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Mary Ann LuceroTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff sexually abused resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Audrey Jeung met with administrator and explained the purpose of today’s visit.
During the course of the investigation, the Department conducted multiple interviews, reviewed documents, and worked with outside agencies such as law enforcement and District Attorneys office to reach the findings. Based on interviews with the alleged resident and the suspected staff person, there were conflicting reports of what may have happened. No residents or other staff witnessed any sexual abuse. An involved outside agency offered a sexual assault exam, which the resident declined. The resident also indicated that they wanted to "drop it" and didn't want to press charges against the alleged staff.

Due to the conflicting reports and no evidence of sexual abuse the allegation is UNSUBSTANTIATED.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore the above allegation is unsubstantiated at this time.
This report is reviewed with Ms. Lucero and a copy is provided during today's visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
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 1