435202819-4-18-2024-26-AS-JJIN-D6KVKN-20240625163038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202819
Report Date: 04/18/2024
Date Signed: 04/18/2024 07:02:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220107110340

FACILITY NAME:	PALO ALTO COMMONS		FACILITY NUMBER:	435202819
ADMINISTRATOR:	LI LI		FACILITY TYPE:	740
ADDRESS:	4075 EL CAMINO WAY		TELEPHONE:	(650) 494-0760
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	250	CENSUS: 172	DATE:	04/18/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Li Li		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not follow COVID-19 guidelines

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 4/18/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint inspection visit. LPA met with Executive Director, Li Li. The purpose of this visit is to deliver the finding of the investigation completed by the Department.

During the visit, LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.

On 01/07/2022, the Department received a report alleging that facility does not follow COVID-19 guidelines.

The Department conducted interviews and record reviews. Based on the information available, it was unable to prove whether the facility did not follow COVID-19 guidelines.

Although the allegation 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 above allegation is unsubstantiated, at this time.

No deficiencies were cited during the visit. Report is reviewed and copy is provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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 1