<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430701864
Report Date: 08/24/2022
Date Signed: 08/24/2022 11:57:58 AM

Substantiated


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
06/24/2022 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20220624141255
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:
11:15 AM
MET WITH:Anahi McKaneTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility tree branch not trimmed, posing a hazard to residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Anahi McKane.

LPA Marrufo conducted an initial complaint investigation visit on 06/29/2022. LPA Marrufo continued to interview residents at later dates. LPA Marrufo interviewed residents R1-R10. LPA Marrufo obtained copies of the resident roster, Work Order Log, and Physical Inspection Summary Report from U.S. Department of Housing and Urban Development dated 04/18/2022. LPA Marrufo also obtained an email from facility staff S1 on 07/11/2022 with attached photographs and a statement that the “old dead tree” was removed from the outside of the building.

See LIC9099-C for more information. Page 1 of 2.

Substantiated
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 3
Control Number 26-AS-20220624141255
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During visit on 06/29/2022, LPA Marrufo observed a tree near the ramp at the facility entrance that was leafless and had a branch that was hanging about 6 feet above the ground. LPA Marrufo did not observe breaks or dents in the branches. LPA Marrufo did not observe the branches to brittle, to pose any hazard, or to obstruct the walkway.

10 out of 10 interviewed residents stated to have not observed or experienced any hazardous trees or branches at the facility, including at the facility entrance.

The Physical Inspection Summary Report does not contain any deficiencies or descriptions of hazards caused by trees or by untrimmed tree branches.

The Work Order Log shows an entry on 04/15/2022 for “Stair way clean up and floor Grait clean up dirt applied to cement” under the category “Landscaping Lawn/shrubs/trees.” The log shows additional Landscaping entries for “Clean All Gutters” on 04/20/2022, and “Clean all storm drains in Lytton 2” on 05/20/2022 and 06/20/2022. LPA Marrufo did not observe any log entry pertaining to tree maintenance in the Work Order Log.

LPA Marrufo attempted to conduct an interview with staff S2, the Director of Facilities, but LPA was unable to reach S2 for an interview. During visit on 07/28/2022, LPA Marrufo observed there to be a tree stump where the tree had previously been. LPA Marrufo interviewed Witness W1 who stated that the tree had been dead and was leaning at a 33 degree angle towards the walkway. W1 stated that the tree posed a safety hazard because it was leaning and the root ball had started being pulled out of the ground.

Based on records review, interviews and observations there is preponderance of evidence to prove the alleged violations did occur, therefore the allegation is substantiated.

See 9099-D for deficiencies cited per the California Code of Regulations, Title 22.

This report was reviewed with Anahi McKane and a copy of the report and appeal rights were 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 3
Control Number 26-AS-20220624141255
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: 08/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2022
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303(a) Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents,
1
2
3
4
5
6
7
Licensee has already removed the tree that was leaning near the walkway. Licensee agrees to inspect all trees on the facility that may pose a hazard to residents and submit a proof of correction by POC date to CCL.
8
9
10
11
12
13
14
employees and visitors. This requirement was not met as evidenced by: Licensee did not ensure that a tree near the a resident walkway was not leaning, posing a potential safety hazard to residents in care.
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.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3