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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 419210115
Report Date: 11/25/2024
Date Signed: 11/25/2024 10:03:39 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
11/19/2024 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241119091846
FACILITY NAME:AVENUE HOME, THEFACILITY NUMBER:
419210115
ADMINISTRATOR:OSYUKI R. HERRERAFACILITY TYPE:
735
ADDRESS:1165 MARSH ROADTELEPHONE:
(650) 362-4246
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:4CENSUS: 4DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Osyuki ReyesTIME COMPLETED:
10:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff allow the clients to smoke inside of the home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 25, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Administrator, Osyuki Reyes and explained the purpose of the visit.

Regarding the allegation, staff allow the clients to smoke inside of the home, according to the reporting party, clients are smoking inside the property in one of the rooms inside the house.

During the investigation, LPA interviewed the administrator, staff, and clients. According to the administrator and staff interviewed, they denied this allegation. There is only one client (R1) who smokes at the facility. R1 denied smoking inside the facility and stated that he/she always smokes in the designated smoking area outside, located on the side of the center deck next to the kitchen.LPA toured the facility and observed all rooms to be odor-free, in good repair, and clean. In addition, LPA observed the desginated smoking area outside.

Therefore, based on the interviews conducted, information received, and observations, the allegation above is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.

Report is reviewed with Administrator and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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