380540292-6-11-2021-14-AS-KHOS-C48KG6-20210622075258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 380540292
Report Date: 06/11/2021
Date Signed: 06/11/2021 10:54:09 AM

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
05/20/2021 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20210520124418

FACILITY NAME:	SAN FRANCISCO TOWERS		FACILITY NUMBER:	380540292
ADMINISTRATOR:	CHRISTINA SPENCE		FACILITY TYPE:	741
ADDRESS:	1661 PINE STREET		TELEPHONE:	(415) 776-0500
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	350	CENSUS: 298	DATE:	06/11/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive Director, Christina Spence		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Facility staff are not dispensing medication as prescribed
Lack of supervision resulting in multiple residents having falls

INVESTIGATION FINDINGS:

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On 6/11/2021, Licensing Program Analyst (LPA) Han conducted an unannounced complaint inspection to deliver the findings. LPA met with the Executive Director and explained the purpose of the visit.

Regarding to staff are not dispensing medication as prescribed, the allegation referred to Resident 1( R1) who at the time had been evaluated and determined able to manage and administer his own medications (as per Resident Functional Evaluation). R1 was readmitted to the facility on May 14, 2021, the facility completed a Resident Functional Evaluation indicating R1 needed reminder of his medication and that the resident was managing and administering his medications with assistance from his/her son. The following day, R1 made a mistake with the administration of medication, so another Resident Functional Evaluation and Service Plan was implemented for the facility to start administering the resident's medication.

This report is continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

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-20210520124418

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: SAN FRANCISCO TOWERS	FACILITY NUMBER: 380540292
	VISIT DATE: 06/11/2021

NARRATIVE

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The complainant also alleged that there was a mistake in the administration of insulin for the same R1. No additional information or proof was forthcoming from the complainant. LPA interviewed Registered Nurses from the facility who denied the allegation.

Regarding to allegation that there was lack of Supervision resulting in multiple residents having fall, LPA interviewed facility's Registered Nurses, Resident Assistant, and the Director of Resident Health Services and they denied the allegation. The facility reported that there was one fall within the last few weeks that resulted in injury and a copy of the Incident Report was provided to LPA. No additional information or proof was forthcoming from the complainant.

Base on this information, record review and interviews during the course of investigation, these allegation are unsubstantiated.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

This report was reviewed and discussed with the Executive Director and a copy is provided.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC9099 (FAS) - (06/04)

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