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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415650019
Report Date: 05/01/2026
Date Signed: 05/01/2026 09:57:35 AM

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
03/06/2026 and conducted by Evaluator Amee Li
PUBLIC
COMPLAINT CONTROL NUMBER: 14-CR-20260306142752
FACILITY NAME:ELYSIANFACILITY NUMBER:
415650019
ADMINISTRATOR:AIMEE SALAZAR-NUNEZFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 2DATE:
05/01/2026
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Long Nguyen, Administrator DesigneeTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Staff hit a youth in care
INVESTIGATION FINDINGS:
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On 05/01/2026 at 9:25 AM, Licensing Program Analyst (LPA) Amee Li made an unannounced visit to the above-listed facility for the purpose of delivering complaint findings for the above allegation. LPA met with Administrator Designee Long Nguyen and explained the purpose of the visit. At the time of the visit, there are two clients in care and one client present. LPA conducted a physical plant inspection and found the facility to be in good repair.

During the investigation, LPA conducted twelve confidential interviews, inspected shift logs and incident reports, and reviewed facility compliance history. LPA found that statements obtained via interview did not support the details of the allegation. Additionally, the documentation reviewed was found to corroborate these statements.

(Continued on LIC9099C.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Pierotti
LICENSING EVALUATOR NAME: Amee Li
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026
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 2
Control Number 14-CR-20260306142752
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: ELYSIAN
FACILITY NUMBER: 415650019
VISIT DATE: 05/01/2026
NARRATIVE
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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 allegation "Staff hit a youth in care" is unsubstantiated.

At the time of this inspection, no Title 22 deficiencies were observed regarding this allegation. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Long Nguyen, Administrator Designee whose signature below confirms receipt.
SUPERVISORS NAME: Kristin Pierotti
LICENSING EVALUATOR NAME: Amee Li
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2