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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601126
Report Date: 07/22/2026
Date Signed: 07/22/2026 01:38:02 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
07/14/2026 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20260714104718
FACILITY NAME:BURLINGAME SENIOR LIVINGFACILITY NUMBER:
415601126
ADMINISTRATOR:BRIAN RAIMUNDOFACILITY TYPE:
740
ADDRESS:250 MYRTLE ROADTELEPHONE:
(650) 343-2747
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:90CENSUS: 60DATE:
07/22/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator, Brian RaimundoTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Staff did not fix residents toilet in a timely manner
INVESTIGATION FINDINGS:
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On July 22, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced 10-day complaint visit. LPA met with the administrator and explained the purpose of today's visit.

Regarding the allegation of- staff did not fix toilet in a timely fashion, the reporting party stated that after resident #1 (R1) moved into the facility, the toilet stopped working and R1 was provided a key to an unoccupied room located next door to access the toilet and R1 was told that it would be fixed by the maintenance worker. However, the toilet was not fixed until 4 days later.

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

According to R1, the toilet has been fixed but on the day of the move in, the toilet was not flushing properly, and he/she was giving the key to use the bathroom next door. R1 stated that he/she used that toilet during the day but not at night because there was no light in the room except for the bathroom.

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

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
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-20260714104718
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: BURLINGAME SENIOR LIVING
FACILITY NUMBER: 415601126
VISIT DATE: 07/22/2026
NARRATIVE
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According to the administrator and the facility director, the toilet was working properly prior to R1’s move-in and they were not aware that it was not working until the day of the move-in. The administrator acknowledged that it took the maintenance worker 4 days to fix it.

After the investigation, this allegation is substantiated as the facility provided R1 to use the toilet in the unoccupied room next door, however, there was no sufficient lighting in that room which resulting in R1 not being able to have access to the toilet at night.

Based on interviews, observation, 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 additional civil penalties.



Report was discussed with the administrator; a copy is provided with Appeal Rights.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20260714104718
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: BURLINGAME SENIOR LIVING
FACILITY NUMBER: 415601126
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2026
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by R1 moved into a room with a not working toilet and R1 was provided with a
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During today's visit, LPA observed that R1's toilet has been fixed.

The administrator will develop a plan of correction to ensure the facility is in good repair at all times and the plan
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key to use the toilet in an unoccupied room next door, however, there was no light in that room which posed a potential health and safety risks to residents in care.
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shall indicate what actions that the facility will take to prevent this from happening again.
The administrator will provide a copy of the plan of correction to CCL by 7/30/2026.
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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.
SUPERVISOR'S NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC9099 (FAS) - (06/04)
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