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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600399
Report Date: 06/11/2021
Date Signed: 06/11/2021 10:10:00 AM

Unsubstantiated


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
09/08/2020 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20200908115607
FACILITY NAME:SAN FRANCISCO RCFEFACILITY NUMBER:
385600399
ADMINISTRATOR:ADELA MORALESFACILITY TYPE:
740
ADDRESS:887 POTRERO AVENUETELEPHONE:
(628) 206-6436
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:59CENSUS: 40DATE:
06/11/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Linda SimsTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
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5
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7
8
9
Facility in disrepair
Not meeting the needs of the residents
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
10
11
12
13
On June 11, 2020 at 0900 LPA Jaime Vado conducted an unannounced complaint
inspection visit to deliver findings regarding the allegations received. LPA met with Linda Sims and explained purpose of today's inspection.

During the course of the investigation LPA interviewed staff and reviewed documentation regarding repairs. It was discovered that the air conditioniner (AC) unit did break down on 09/04/2020 at the beginning of a heat wave. The facility addressed the repairs immediately with facility services but the repair was put on hold due to a part that was needed. Documentation show that the part needed for repair was ordered but delayed in recieving. The AC unit was repaired once the part was received and the AC was back up and running by 09/10/2020. The doors in question that are broken are not broken. They have the ability to lock but are sometimes unlocked to allow residents to come and go to the outside gated area where residents are allowed to smoke and walk around. Staff also leave this door propped open at times so that residents can come and go with staff supervison. At the same time as the AC was not working there was a heat wave in the area. Facility staffs intention was to assist in cooling the facility down by opening some doors and bringing in fans to move cooler air through out the facility in attempt to cool the facility to cool it down. Additionally water and ice water was provided to the residents. In regards to residents with breathing conditions were advised to not go outside due to the smokey conditions because of the wildfires and heatwave that taking place around the area. The allegations are deemed 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.


Report is discussed with Linda Sims.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Jaime Vado
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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