430701864-8-21-2026-26-AS-ACON-DXJUZZ-20260902160221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430701864
Report Date: 08/21/2026
Date Signed: 08/21/2026 06:10:27 PM

Unsubstantiated

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
05/28/2026 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20260528082532

FACILITY NAME:	LYTTON GARDENS COMMUNITY CARE		FACILITY NUMBER:	430701864
ADMINISTRATOR:	ANAHI MCKANE		FACILITY TYPE:	740
ADDRESS:	649 UNIVERSITY AVENUE		TELEPHONE:	(650) 617-7338
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94301
CAPACITY:	55	CENSUS: 37	DATE:	08/21/2026
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Anahi McKane and Mika Blockman		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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- Staff does not ensure food assistance is provided per residents needs and services plan
- Staff does not ensure call signal system is in good repair
- Licensee does not ensure facility has sufficient staffing to meet the care needs of residents in a timely manner
- Staff does not ensure hot water temperature is maintained for residents in care

INVESTIGATION FINDINGS:

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LPA Jeung met with receptionist and administrator and observed kitchen operation at 401 Webster Street--where independent residents reside--reviewed staff and client files, interviewed residents, and checked hot water temperature in random rooms on the 1st and 2nd floors.

Based on observations, interviews with staff and residents, and review of staff training documentation, these allegations are determined to be unsubstantiated. Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur.

Special food requirements are met by kitchen and care staff, who are provided with written daily instructions. This includes residents who require food to be cut into small pieces.
Emergency call system is available in all residents' rooms and a pendant alarm can be worn. A report of device activity response times is reviewed for the month of May 2026 and there are several clients who experienced long response times. However, it cannot be verified that this allegation pertains to the in room emergency call system. Furthermore, administrator has been pro-active and regularly (CONT.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

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 4

Control Number 26-AS-20260528082532

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: LYTTON GARDENS COMMUNITY CARE	FACILITY NUMBER: 430701864
	VISIT DATE: 08/21/2026

NARRATIVE

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reviews the Device Activity Reports to identify the residents who experienced unusually long response times and investigates the causes. There may be technical issues involved in some of these long responses, and administrator stated that this would be reported to a service provider. A client who regularly experienced long response times--according the the Device Activity Report--reported that response times by staff was OK. Staff did not complain that they were unable to meet the care needs of residents.

Hot water temperature tested between 109 and 118 degrees F in 8 random rooms, although one resident reported that the hot water temperature sometimes fluctuates.

SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/28/2026 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20260528082532

FACILITY NAME:	LYTTON GARDENS COMMUNITY CARE		FACILITY NUMBER:	430701864
ADMINISTRATOR:	ANAHI MCKANE		FACILITY TYPE:	740
ADDRESS:	649 UNIVERSITY AVENUE		TELEPHONE:	(650) 617-7338
CITY:	PALO ALTO	STATE:CA	ZIP CODE:	94301
CAPACITY:	55	CENSUS: 37	DATE:	08/21/2026
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Anahi McKane		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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- Staff did not ensure sanitary food service practices were followed
- Staff does not ensure resident is handled with care while providing bathing assistance

INVESTIGATION FINDINGS:

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Based on information reported by and obtained from facility staff, as well as documentation in personnel records, theie allegations are substantiated. The preponderance of evidence standard has been met.

In May 2026, it is alleged that an identified staff used her gloved hands to cut up food and handled client roughly during bathing assistance. This poor job performance was identified and addressed by facility management and staff was counseled and received written warnings.

Deficiency of the California Code of Regulations, Title 22, is cited on a following page.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20260528082532

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: LYTTON GARDENS COMMUNITY CARE	FACILITY NUMBER: 430701864
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/21/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/04/2026 Section Cited CCR 87411(d)	1 2 3 4 5 6 7	PERSONNEL REQUIREMENTS--GENL All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill... as appropriate for the job assigned and as evidenced by safe and	1 2 3 4 5 6 7	Proof of correction to be submitted to CCLD BY DUE DATE, which shall include what measures have been taken to address staff #1 poor job performance.
	8 9 10 11 12 13 14	effective job performance. This requirement was not met, as staff #1 lacked skills to provide personal care & safely handle food. Licensee failed to ensure that staff are completent to provide personal care & sanitary food service practices, which posed a potential health, safety or personal rights risk.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Cowan April
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

LIC9099 (FAS) - (06/04)

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