385600235-8-10-2026-14-AS-BCHN-DYDUQW-20260929154748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600235
Report Date: 08/10/2026
Date Signed: 08/10/2026 01:13:35 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
08/06/2026 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20260806135806

FACILITY NAME:	KOKORO ASSISTED LIVING		FACILITY NUMBER:	385600235
ADMINISTRATOR:	BRYCE SAXTON		FACILITY TYPE:	740
ADDRESS:	1881 BUSH ST		TELEPHONE:	(415) 776-8066
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	61	CENSUS: 49	DATE:	08/10/2026
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Sakae Hamilton		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff locked resident's out of their rooms
Staff did not complete a reappraisal after a change in resident’s condition
Staff did not provide assistance with medication
Staff did not ensure dishes are in good repair
Staff do not provide adequate food service to residents
Staff engaged in a physically inappropriate interaction with resident

INVESTIGATION FINDINGS:

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On 8/10/2026, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Director of Resident Services (DRS), Sakae Hamilton and explained the purpose of the visit.

For the allegation of Staff locked resident's out of their rooms, LPA interviewed staff members. Three out of three mentioned that they don’t lock out residents from their rooms. S1 shared that all staff has keys and are able to let residents in their rooms in case it gets accidentally locked.

Regarding the allegation of Staff did not complete a reappraisal after a change in resident’s condition, while the resident (R2) has the same diagnosis from when R2 started living in the facility, R2s records show no changes in condition as the there wasn't any significant change. Based on records review, R2 is independent and is able to do and manage all activities of daily living except for room housekeeping.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026

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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Control Number 14-AS-20260806135806

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: KOKORO ASSISTED LIVING	FACILITY NUMBER: 385600235
	VISIT DATE: 08/10/2026

NARRATIVE

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For the allegation of Staff did not provide assistance with medication, R2 is able to manage his/her own medications based on the records reviewed. R2 is able to store his/her own medications in the room. R2 is able to lock the room whenever R2 goes out of the facility.

Regarding the allegation of Staff did not ensure dishes are in good repair, LPA observed some of the plastic cups being used have issues on the rim due to the cleaning process. Facility has been using disposable cups in the meantime as the Kitchen Director is still looking for a better replacement for the cups.

On the allegation of Staff do not provide adequate food service to residents, LPA reviewed the resident’s menu for the 1st and 2nd week of August 2026. LPA observed that there is a variety of food served such as vegetables, fish, chicken, beef and pork for different days of the week. LPA also observed a list of residents with special diets and requests when LPA toured the kitchen. The list consists of what resident’s don’t want to eat and what substitutes the residents want. According to the DRS, if residents need a modified diet then it will be adjusted.

For the allegation of Staff engaged in a physically inappropriate interaction with resident, all staff interviewed mentioned that they haven’t seen any staff snatch an ipad from a resident (R1). S2 mentioned that for R1 who uses the ipad, usually the ipad is taken and placed on the side of the R1. Staff does this whenever it is time for the resident to eat.

Based on interviews and records review, the department has determined that although the allegations 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.

Report is reviewed and copy is provided.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026

LIC9099 (FAS) - (06/04)

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