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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 04:37:42 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
07/29/2022 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20220729133339
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:
10:41 AM
MET WITH:Doris LeeTIME COMPLETED:
04:45 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 Adminstrator Doris Lee.

During visit, LPA Marrufo toured the facility and interviewed Adminstrator Doris Lee and staff S1. LPA Marrufo previously interviewed S2 on 07/28/2022. LPA Marrufo also conducted a telephone interview with resident R1 while at the facility. During the visit on 07/28/2022 for a prevoius complaint, LPA Marrufo observed a COVID Notificaton dated 07/27/2022 posted on the glass panel at the Front Desk stating there is a current Independent Living resident case of COVID in Lytton Building II. LPA Marrufo did not observe the posting placed in the elevator near the entance.

During interview, Administrator Doris Lee stated that an Independent Living resident tested positive for COVID on 07/25/2022 and English, Russian, and Chinese versions of the COVID Notificaton were placed on 07/27/2022. 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-20220729133339
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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During interview, staff S1 stated to have placed copies of the posting on 2 out of 2 elevators in the Assisted Living Building Lytton II, left extra copies of the posting at the Front Desk, and posted them in 3 out of 3 elevators in the Independent Living Building I and in 3 out of 3 locked bulletin boards in Lytton I.

During visit, LPA Marrufo observed the COVID Notice posted on the glass panel of the Front Desk in Lytton II, on 2 out of 3 locked bulletins, 1 Russian COVID Notification posting in 1 out of 3 elevators, and 3 out of 3 elevators had no English or Chinese postings.

Administrator Lee, S1 and S2 stated that a resident has been removing the COVID postings.

Based on interview with resident R1, it was confirmed that R1 did take down a posting of a notification in one of the Lytton I elevators 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