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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701864
Report Date: 08/24/2022
Date Signed: 08/24/2022 11:54:14 AM

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
08/08/2022 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20220808170457
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:
08/24/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Anahi McKaneTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility is not posting COVID notices in Chinese
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Anahi McKane.

On 08/08/2022, the Department received a complaint with the above allegation. LPA Marrufo conducted an initial complaint investigation visit on 08/12/2022. During the investigation, LPA Marrufo interviewed residents R1-R5 and attempted interviews with R6-R8. LPA Marrufo interviewed staff S1-S2. LPA Marrufo also toured the facility and observed facility COVID notification postings.

2 out of 5 interviewed residents stated to not be able to read COVID postings in English but had a family member translate the postings for them. 3 out of 5 residents stated to be able to read COVID postings in English. 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: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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-20220808170457
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: 08/24/2022
NARRATIVE
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1 of out 2 interviewed staff stated to have observed COVID postings in Chinese and Russian translations, and then later observed that the Chinese and Russian postings were missing. The other interviewed staff stated COVID notices were posted on all the residents’ doors in the facility, including both Assisted Living and Independent Living residents.

LPA Marrufo toured both the Lytton I and Lytton II buildings, and observed there to be COVID notification postings in various areas in each building in English, Chinese, and Russian.

The Department does not have regulations or Provider Information Notices (PINs) that specify how facilities are required to notify residents about new COVID cases in the facility or require facilities notify residents in languages besides English.

Based on information from interviews conducted with staff, records reviewed, and observations, 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 Anahi McKane and a copy of the report was provided.


Page 2 of 2.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2