380540203-9-29-2020-14-AS-JMOS-BTXU7V-20200930152030

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 380540203
Report Date: 09/29/2020
Date Signed: 09/29/2020 04:27:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/28/2020 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20200728121542

FACILITY NAME:	BUENA VISTA MANOR HOUSE		FACILITY NUMBER:	380540203
ADMINISTRATOR:	WALL, DAVID		FACILITY TYPE:	740
ADDRESS:	399 BUENA VISTA EAST		TELEPHONE:	(415) 863-1721
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY:	87	CENSUS: 48	DATE:	09/29/2020
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	David Wall		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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-Illegal Eviction

INVESTIGATION FINDINGS:

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On 9/29/20 Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced complaint investigation regarding the above allegation. LPA met with Administrator David Wall via tele-visit due to Covid-19 procedures and explained the purpose of the investigation.

Regarding the allegation of illegal eviction, the Department investigation found the following: A Resident (R1) was sent to the hospital due to the discovery of several wounds on his/her feet. After treating the wounds, R1 was discharged back to the facility, with a plan requiring home health nurse 3 times a week to address R1's medical needs. The complainant indicated that the Administrator, David Wall, would not allow R1 to come back to the community. Administrator, David Wall, acknowledged that R1 could not return to the facility due to his need of higher level of care, and also stated that R1's responsible party agreed that the resident needed to go to another facility to provide for higher level of care. R1’s responsible party stated that he/she wanted R1 to come back to the community until he/she was able to find another community for R1. However, the administrator told the responsible party that he would not allow R1 to come back due to his medical needs requiring a higher level of care.

Report Continued on LIC9099-C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

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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Control Number 14-AS-20200728121542

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUENA VISTA MANOR HOUSE	FACILITY NUMBER: 380540203
	VISIT DATE: 09/29/2020

NARRATIVE

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Administrator, David Wall, stated that R1 was not being evicted, but he was not letting him return back to the community due to R1's medical needs. Administrator stated that his community is Assisted Living and R1 needed to go to a Skilled Nursing Facility (SNF).

The information available shows that R1 was discharged back to the facility with an appropriate care plan. It was the responsibility of the licensee to accept the resident back and then, if needed, perform a reappraisal of the resident. If the reappraisal showed that the licensee could not meet those needs, then the licensee needed to issue a 30-day eviction notice and follow corresponding eviction procedures. Based on this information, there is preponderance of evidence that R1 was illegally evicted from the community when the licensee refused to accept the resident back, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies of the California Code of Regulations, Title 22, are cited on the attached LIC9099-D. Appeal Rights given. This report was discussed and reviewed with Administrator, David Wall.

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

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Control Number 14-AS-20200728121542

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUENA VISTA MANOR HOUSE	FACILITY NUMBER: 380540203
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 09/30/2020 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	87224 Eviction Procedures:(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5).Thirty (30) days written notice to the resident is required...(4)If, after admission...a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator has agreed to review Title 22 Eviction Procedures and send CCLD proof in writing. Proof of correction must be received by CCLD office no later than due date (9/30/20)
	8 9 10 11 12 13 14	Based on interviews and record reviews, the licensee did not ensure the resident was given proper 30 day eviction procedures which poses an immediate health, safety, and personal rights risk to persons 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.

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

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