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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600399
Report Date: 08/25/2021
Date Signed: 08/25/2021 04:53:03 PM

Unfounded


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
06/03/2021 and conducted by Evaluator Mohamed Filouane
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20210603123136
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:
08/25/2021
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Adela MoralesTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff engaging in inappropriate interactions in the presence of resident's.
Staff made an inappropriate comment towards resident.
INVESTIGATION FINDINGS:
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On 8/25/21, Licensing Program Analyst (LPA) Mohamed Filouane conducted a follow-up visit regarding this complaint investigation. LPA Filouane met and spoke Administrator Adela Morales, explained the purpose of the visit, and then delivered the findings.

Concerning the allegation of staff engaging in inappropriate interactions in the presence of residents, LPA Filouane interviewed the Administrator, the Director of Behavioral Health Center, Linda Sims, and facility staff members. The Administrator stated the resident in question believes that staff member interacts inappropriately when they sit close to each other or when staff are sitting in an alleged wrong manner at their desks. There is no additional evidence to support the inappropriate interactions allegation in the presence of residents.

Concerning the allegation of staff making inappropriate comments to a resident, LPA Filouane interviewed the Administrator, the Director of Behavioral Health Center, Linda Sims, and facility staff members.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Mohamed Filouane
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 14-AS-20210603123136
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 RCFE
FACILITY NUMBER: 385600399
VISIT DATE: 08/25/2021
NARRATIVE
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 Information gathered reveals that one staff member (S1) allegedly told a resident that other staff members informed S1 that the resident is making up stories and reporting things that are not true. S1 denies this allegation. There were no witnesses present to support the allegation. Under Title 22 regulations, there was no inappropriate comment made towards the resident in question.

This agency has investigated the complaint. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Exit interview conducted with the Administrator. A copy of this signed report will be emailed to the Administrator.
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Mohamed Filouane
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2