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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600399
Report Date: 09/01/2026
Date Signed: 09/01/2026 03:11:22 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
06/01/2026 and conducted by Evaluator Yi Sam Jian
COMPLAINT CONTROL NUMBER: 14-AS-20260601163306
FACILITY NAME:SAN FRANCISCO RCFEFACILITY NUMBER:
385600399
ADMINISTRATOR:CHARISSE LIFACILITY TYPE:
740
ADDRESS:887 POTRERO AVENUETELEPHONE:
(628) 206-6402
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:59CENSUS: 45DATE:
09/01/2026
UNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Charisse LiTIME COMPLETED:
03:37 PM
ALLEGATION(S):
1
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9
-Staff did not prevent residents from smoking in the facility.
INVESTIGATION FINDINGS:
1
2
3
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5
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10
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13
On 09/01/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unnannounced complaint visit. LPA met with administrator, Charisse Li, LPA explained the purpose of the visit.

Regarding the allegation that staff did not prevent residents from smoking inside the facility, the Department conducted investigation, document reviews, interviews with residents and staff consistently indicated that residents smoke outside or in the designated patio area and that indoor smoking was not occurring. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove whether the allegations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. Report is reviewed and a copy of this report is provided to the administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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