385600423-5-24-2023-14-AS-KHOS-CSBN82-20230530101338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600423
Report Date: 05/24/2023
Date Signed: 05/24/2023 10:44:13 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
08/03/2020 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20200803161119

FACILITY NAME:	SAGEBROOK SENIOR LIVING AT SAN FRANCISCO		FACILITY NUMBER:	385600423
ADMINISTRATOR:	ANGELA L BOUCHER-TURIN		FACILITY TYPE:	740
ADDRESS:	2750 GEARY BLVD		TELEPHONE:	(415) 346-0246
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	111	CENSUS: 61	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jennine Chan		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Food service is inadequate
Facility staff failed to meet residents' needs
Facility staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the above allegations. LPA met with health and wellness director Jennine Chan and explained the purpose of today's visit.

During the investigation LPA conducted multiple interviews, reviewed pertient complaint documents, and obtained photos. The above allegations could not be proved or disporved by LPA during the investigation process. LPA could not meet the perponderance of evidence standard to prove that they did take place. These allegations are unsubstantiated.

Report is reviewed with Jennine Chan. No citations issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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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