385600423-3-15-2023-14-AS-KHOS-CQCN6P-20230328101128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600423
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:38:45 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 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
12/30/2022 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20221230101902

FACILITY NAME:	SAGEBROOK SENIOR LIVING AT SAN FRANCISCO		FACILITY NUMBER:	385600423
ADMINISTRATOR:	FAIMAFILI HOWARD		FACILITY TYPE:	740
ADDRESS:	2750 GEARY BLVD		TELEPHONE:	(415) 346-0246
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	111	CENSUS: 69	DATE:	03/15/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sales Director, David Estrada		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Facility failed to provide adequate food service

INVESTIGATION FINDINGS:

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On 3/15/2023, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings to complaint # 14-AS-20221230101902. LPA Han met with the Sales Director and the resident service director. LPA explained the purpose of the visit.

Regarding allegation of - facility failed to provide adequate food service, the reporting party stated that, resident -in- question (R1) reported that the facility served bad hamburger and uncooked hot dogs, the facility did not provide the foods that R1 had requested for and instead, provided the foods that R1 did not order and R1 was told by staff that there was no snacks available.

LPA interviewed the administrator who denied the allegation and stated that R1 did not like hamburger as R1 did not eat it until 4 hours later and the hot dog was fully cooked but the way it was cooked left the center a little pinkish. The administrator also stated that there is always snacks such as chips, cookies and fruits in the dining room bistro and staff checks it everyday to replenish it when needed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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-20221230101902

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAGEBROOK SENIOR LIVING AT SAN FRANCISCO	FACILITY NUMBER: 385600423
	VISIT DATE: 03/15/2023

NARRATIVE

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Concerning to R1 did not get the food items as ordered, the administrator stated that upon R1's admission, R1 selected the items from the weekly menu for breakfast, lunch, and dinner and when R1 did not get items as ordered, staff went to the kitchen and got it. The administrator also stated that since the mistakes were reported, the management team such as the resident care director, the dining service director and the administrator have met with R1 several times to improve R1's dining experience. In addition, the administrator has implemented a new system to improve tray/meal accuracy.

According to the dining service director, he/she has met with R1 multiple times concerning food preferences and accuracy. He/she has reminded kitchen staff to check food accuracy before it leaves the kitchen and in-serviced them on improving communication. The dining service director also stated that since the new system that was implemented by the administrator, tray/meal accuracy has improved for R1. In addition, the facility staff brought R1 additional snacks that R1 did not order to ensure R1 has enough of it but R1 mistaken it as staff did not follow his/her food preferences.

LPA interviewed facility staff who stated that when R1 did not get the food items as ordered, they would go to the kitchen and get it for R1 but that only happened when R1 was first admitted to the facility.

LPA interviewed 4 residents and all of them reported that the facility serves good food, the dining experience is great and there are snacks available.

Based on observation, interviews and record reviews during the course of the investigation this allegation is deemed to be unsubstantiated. However during the investigation visit, LPA reviewed R1's selective menu and under beverages, R1 selected orange juice but R1 was served apple juice. This observation will be documented on an advisory notes (LIC 9102 Technical Assistance).

Although the above allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC9099 (FAS) - (06/04)

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