415601112-8-26-2025-14-AS-ACON-DLDVZU-20250910165318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601112
Report Date: 08/26/2025
Date Signed: 08/26/2025 03:42:02 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
04/17/2025 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20250417165434

FACILITY NAME:	MILLBRAE ASSISTED LIVING HOME		FACILITY NUMBER:	415601112
ADMINISTRATOR:	PO, GINGER		FACILITY TYPE:	740
ADDRESS:	1001 HEMLOCK AVE		TELEPHONE:	(650) 689-5776
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY:	48	CENSUS: 45	DATE:	08/26/2025
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Mary Ann Lucero		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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9

- Staff person touched residents in a sexual manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Audrey Jeung met with administrtaor and explained the purpose of today’s visit.
During the course of the investigation, the Department conducted multiple interviews, reviewed documents, and worked with other outside agencies such as law enforcement and District Attorneys office to reach the findings. Based on interviews with the alleged victims, no one conclusively indicated that S1 sexually touched a resident, but alleged other actions such as kissing a resident on his/her cheek. No resident or the suspected abuser admitted to touching a resident in a sexual manner.

Based on these observations, this allegation is determined to be UNSUBSTANTIATED.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations 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)

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