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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430700136
Report Date: 05/09/2025
Date Signed: 05/09/2025 09:53:29 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2025 and conducted by Evaluator Kiran Jain
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20250502100433
FACILITY NAME:CHANNING HOUSEFACILITY NUMBER:
430700136
ADMINISTRATOR:RHONDA BEKKEDAHLFACILITY TYPE:
741
ADDRESS:850 WEBSTER STREETTELEPHONE:
(650) 327-0950
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:264CENSUS: 230DATE:
05/09/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Beth ShirleyTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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9
Resident was left on the floor for an extended period of time due to lack of supervision
Staff did not ensure that resident was adequately hydrated
INVESTIGATION FINDINGS:
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On May 09, 2025, at 08:50 AM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Complaint Investigation visit. Upon arrival, LPA met with the Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. The AAD informed the LPA that the total census of the facility was 231, including 28 residents in Assisted Living.

LPA requested and collected the Resident Roster and the Staff schedule records for the period of April 28, 2025 to April 30, 2025. LPA reviewed the Resident Roster record and noticed that the resident (R1) mentioned in the complaint narrative was a direct resident of skilled nursing section of the facility, which is not licensed by CCLD.

LPA interviewed AAD, who stated that some of the residents in the skilled nursing unit are admitted as direct (permanent) and some as temporarily from Assisted Living or the Independent Living sections.

Continued on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
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 26-AS-20250502100433
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: CHANNING HOUSE
FACILITY NUMBER: 430700136
VISIT DATE: 05/09/2025
NARRATIVE
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Based on observations, interview conducted with the Assistant Administrator, and records reviewed, the department has determined that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, the allegation is UNFOUNDED.

No deficiencies were cited under the California Code of Regulations, Title 22.

An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of the report.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2