385600377-10-21-2024-14-AS-ACON-DABU37-20241023151304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600377
Report Date: 10/21/2024
Date Signed: 10/21/2024 10:38:33 AM

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
07/25/2024 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20240725123729

FACILITY NAME:	MERCED GIRARD RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	385600377
ADMINISTRATOR:	WU, JAMES O.D		FACILITY TYPE:	740
ADDRESS:	129 GIRARD STREET		TELEPHONE:	(415) 467-8900
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94134
CAPACITY:	42	CENSUS: 39	DATE:	10/21/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Administrator - Michael Lee		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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- Facility staff did not seek medical attention for resident in a timely manner
- Facility staff yelled at resident in care

INVESTIGATION FINDINGS:

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On 10/21/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the complaint allegations received. LPA met with staff initially then the administrator Michael Lee.

During the investigation LPA conducted interviews and reviewed pertinent documents related to the allegations. Per interviews with facility staff, medical attention was sought for the resident when they were alerted by the family of the resident that there was a possible medical issue. Staff attested to caring and feeding the resident that morning and bringing the resident to their room per resident request with no issues. Regarding the staff yelling, LPA could not determine if this took place and per observations and interviews, its common for staff to speak loudly to each other but not in an angrily way directed toward residents per observations and interviews conducted. During the investigation LPA could not prove or disprove that the allegations took place and due to conflicting information the allegations are unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024

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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