385600423-5-3-2023-14-AS-CSMH-CRJNVH-20230505104758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600423
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:45:46 PM

Unfounded

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
03/09/2023 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230309165530

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: 67	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Sales Director, David Estrada		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff illegally evicted resident

INVESTIGATION FINDINGS:

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On 5/3/2023, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings to complaint # 14-AS-20230309165530. LPA Han met with sales director and LPA explained the purpose of the visit.

Regarding to allegation of- staff illegally evicted resident, the reporting party stated that he/she did not report it. However, CCL received this complaint, and LPA conducted an investigation.

As part of the investigation, LPA interviewed facility administrator, and R1's case manager.

LPA interviewed the administrator who denied the eviction and stated that R1 was admitted from a hospital with a plan to stay at the facility for 30 days then return home.

After the 30 days, the facility was directed by R1's case manager that R1 wanted to return home as planned and the facility worked with R1's case manager to get R1 home.

Unfounded

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: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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-20230309165530

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: 05/03/2023

NARRATIVE

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In addition, the administrator stated that on the day of the discharge, facility provided a caregiver to escort R1 home where R1's friend was present.

LPA spoke to R1's case manager who validated that the facility was instructed to discharge R1 home per R1's directive.

After the investigation, the Department has found that this allegation to be UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis.

This report is reviewed and discussed with the sales director

A copy is provided.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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