385600359-9-22-2021-14-AS-KHOS-C7AKYG-20210928081906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600359
Report Date: 08/30/2021
Date Signed: 09/22/2021 11:03:50 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
08/18/2021 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20210818082130

FACILITY NAME:	CARLISLE, THE		FACILITY NUMBER:	385600359
ADMINISTRATOR:	FOX, ALAN		FACILITY TYPE:	740
ADDRESS:	1450 POST ST		TELEPHONE:	(415) 929-0200
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	130	CENSUS: 71	DATE:	08/30/2021
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Executive Director, Stephanie Schmautz		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff wrote inappropriate letter to resident

INVESTIGATION FINDINGS:

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9/22/2021- This report has been amended on this date to clarify the verbiage.

On 8/30/2021, Licensing Program Analyst (LPA) Han conducted an unannounced 10-day initial on-site complaint inspection. LPA was screened by the receptionist at the entrance. LPA met with the Executive Director, Stephanie Schmautz. LPA explained the purpose of the visit and reviewed the allegation.

Regarding allegation of : staff wrote inappropriate letter to resident, LPA reviewed the daily census to determine the number of resident in care and to determine the names of the residents.

Approximately five weeks ago, the facility has informed the Department of an incident which may have triggered this complaint. After reviewing the incident, LPA spoke to the Executive Director at the time (facility has a new Executive Director) who reported that the incident has been resolved and the previous Executive Director took actions to prevent incident from happening again and ensuring resident's safety.

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

Although the above investigation 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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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