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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600864
Report Date: 05/31/2023
Date Signed: 05/31/2023 10:47:41 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2023 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230206103123
FACILITY NAME:LAKEVIEW LODGEFACILITY NUMBER:
415600864
ADMINISTRATOR:CAMPBELL, ROSALINDAFACILITY TYPE:
740
ADDRESS:530 LAKEVIEW WAYTELEPHONE:
(650) 369-7476
CITY:EMERALD HILLSSTATE: CAZIP CODE:
94062
CAPACITY:49CENSUS: DATE:
05/31/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Zack PilkertonTIME COMPLETED:
10:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff engaged in verbal altercation in presence of resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) conducted an unannounced complaint investigation visit in order to deliver the findings regarding the allegations. LPA met with administrator Zack Pilkerton and explained purpose of today's visit.

During the course of the investigation interviews were conducted and documentations was reveiwed. Per interviews the altercation was discovered to be a verbal disagreement between resident's responsible party members regarding an eviction notice served due to non-payment and facility licensee and administrator present. The responsible party members were visiting the resident when the disagreement happened. It is one party's word over the other in regards to who was at fault and who was at fault during the disagreement.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

Report is reveiwed with the administrator. No citations issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2023 and conducted by Evaluator Jaime Vado
COMPLAINT CONTROL NUMBER: 14-AS-20230206103123

FACILITY NAME:LAKEVIEW LODGEFACILITY NUMBER:
415600864
ADMINISTRATOR:CAMPBELL, ROSALINDAFACILITY TYPE:
740
ADDRESS:530 LAKEVIEW WAYTELEPHONE:
(650) 369-7476
CITY:EMERALD HILLSSTATE: CAZIP CODE:
94062
CAPACITY:49CENSUS: DATE:
05/31/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Zack PilkertonTIME COMPLETED:
10:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility director is an incompetent person
Facility did not allow visitor
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) conducted an unannounced complaint investigation visit in order to deliver the findings regarding the allegations. LPA met with administrator Zack Pilkerton and explained purpose of today's visit.

During the course of the investigation interviews were conducted and documentation was reviewed. Per items discussed and reviewed the visitations were allowed and per the visitation log reviewed visitations to the resident did take place. In regards to facility director being incompetent, per interactions, discussions, and facility operation LPA did not discover any merit substantiate such a claim. These allegations are unfounded.

This agency has investigated the complaint alleging, facility director is an incompetent person, and facility did not allow visitor, we have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Report is reveiwed with the administrator. No citations issued.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2