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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701864
Report Date: 08/04/2022
Date Signed: 08/04/2022 04:39:24 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
07/25/2022 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20220725115214
FACILITY NAME:LYTTON GARDENS COMMUNITY CAREFACILITY NUMBER:
430701864
ADMINISTRATOR:DORIS LEEFACILITY TYPE:
740
ADDRESS:649 UNIVERSITY AVENUETELEPHONE:
(650) 617-7338
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:55CENSUS: 42DATE:
08/04/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Doris LeeTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Facility is not posting notices about a COVID case
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Doris Lee.

LPA Marrufo conducted a previous visit on 07/28/2022. LPA Marrufo interviewed resident R1, staff S1-S2 and Administrator Doris Lee. LPA Marrufo toured the facility and obtained a copy of the COVID Notice dated 07/25/2022 written by S1 notifying the facility community that there was a COVID positive resident in the Assisted Living community.

During interview, S1 and Administrator Lee state that resident R2 had tested positive for COVID on 07/23/2022. S1 stated to have posted the COVID Notice on 07/25/2022 on 2 out of 2 facility elevators. S1 stated that a resident removed the COVID Notice postings about two hours after they were initially posted and there is an ongoing issue with a resident removing postings
See LIC9099-C for more information. Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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-20220725115214
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: 08/04/2022
NARRATIVE
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S2 states a resident has been taking the postings down.

Based on interview with resident R1, it was confirmed that R1 did take down a posting of a notification of another COVID case to make a copy. R1 stated to have returned the posting after making a copy.

The regulations do not state a time frame for making postings after a COVID case has been confirmed. The Department recommends as best practice to post a notice as soon as possible.

Based on information from interviews conducted with staff and resident and review of records, although the allegation listed above 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 is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22

This report was reviewed with Administrator Doris Lee and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2