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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601178
Report Date: 07/15/2026
Date Signed: 07/15/2026 02:16:20 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
05/22/2026 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20260522134204
FACILITY NAME:OAKMONT OF BURLINGAMEFACILITY NUMBER:
415601178
ADMINISTRATOR:JANNA O'SULLIVANFACILITY TYPE:
740
ADDRESS:1818 TROUSDALE DRIVETELEPHONE:
(650) 692-2805
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:97CENSUS: 81DATE:
07/15/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Janna O'SullivanTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff did not provide a full refund upon resident’s death
Facility staff do not respond to authorized representative
INVESTIGATION FINDINGS:
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On July 15, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to delivery the complaint investigation findings. LPA met with the administrator and LPA explained the purpose of today's visit.

Regarding allegation of - facility staff did not provide a full refund upon resident’s death, the reporting party stated that resident #1 (R1) passed away in the beginning of March and R1’s room was cleaned and inspected by a facility staff 2 days later, however, the facility did not refund the remaining March payment when this allegation was made.

As part of the investigation, LPA interviewed the administrator and reviewed documents.

During LPA’s visit on 5/28/2026, LPA interviewed the administrator who presented the refund checks of R1 to LPA and stated that the checks were cut on 3/17/2026 and the facility attempted to call the responsible party and ask for a form of mail that he/she preferred but there was no answer so the checks were not mailed. The administrator did not remember who and when the calls were made.

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

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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-20260522134204
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: OAKMONT OF BURLINGAME
FACILITY NUMBER: 415601178
VISIT DATE: 07/15/2026
NARRATIVE
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On June 12, 2026, the administrator provided a copy of the facility phone call logs for the month of March, and it revealed that three calls were made to the responsible party, however, those calls were made before the refund checks were cut. Therefore, the facility could not prove that R1's responsible party was notified of the refund checks.

Based on the admission agreement, it stated that in the event of the death of a resident, the community shall refund any fees paid in advance covering the time after the removal of deceased resident’s personal property from the suite to the individual(s) or entity contractually responsible for the fees, or as applicable, the resident’s estate, within fifteen (15) days following the removal of the deceased resident’s personal property.

After the investigation, this allegation is substantiated as during LPA's visit on 5/28/2026, LPA observed the refund checks were at the facility and the facility could not prove that R1's responsible party was notified of the refund checks.

Regarding the allegation of - facility staff do not respond to authorized representative, the reporting party stated that in January 2026, R1’s responsible party provided a letter to the administrator inquiring about R1’s monthly rent and care increase. However, they did not get any response back from the facility.

As part of the investigation, LPA interviewed the administrator who acknowledged that the letter was received on January 2, 2026 and the administrator had a verbal conversation with the Regional Director about it but did not get any responses back. Therefore, there was no follow-up provided to R1’s responsible party.

After the investigation, this allegation is substantiated.

Based on interviews, record reviews, and observations 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 civil penalties.
This report is reviewed and discussed with the administrator; a copy is provided with Appeal Rights provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20260522134204
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: OAKMONT OF BURLINGAME
FACILITY NUMBER: 415601178
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2026
Section Cited
HSC
1569.652(c)
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§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds(c)A refund of any fees paid in advance..within 15 days after the personal property is removed.
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During today's visit, the administrator stated that they are in communication with R1's RP regarding the checks.
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This requirement is not met as evidenced by based on record reviews, interviews and observation, R1 passed away in the begining of March 2026 and all of R1's personal property was removed 2 days later and as of May 2026 which poses a potential health and safety risks to residents in care.
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The administrator will develop a plan to ensure facility is in compliance with resident refunds. The administrator will provide a copy of the plan to CCL by 7/24/2026.
Type B
07/22/2026
Section Cited
CCR
87468.1(a)(9)
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87468.1Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(9) To have communications to the licensee from their representatives answered promptly and appropriately
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The administrator will develop a plan of correction to ensure resident's representatives inquires are answered promptly and appropriately. The administrator will provide a copy of the plan of correction to CCL by
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This requirement is not met as evidenced by based on record reviews, interviews and observations, R1's responsible party provided a letter to administrator inquiring about R1's monthly payment but did not get answered promptly which posed a potential health and safety risks to residents in care.
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7/25/2026.
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: 07/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3