385600423-9-13-2024-14-AS-KHOS-D9LPJZ-20240930112224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600423
Report Date: 09/13/2024
Date Signed: 09/13/2024 12:44:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
07/31/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20240731085313

FACILITY NAME:	SAGEBROOK SENIOR LIVING AT SAN FRANCISCO		FACILITY NUMBER:	385600423
ADMINISTRATOR:	PHOEBIE CARCOT		FACILITY TYPE:	740
ADDRESS:	2750 GEARY BLVD		TELEPHONE:	(415) 346-0246
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	111	CENSUS:	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Program Director, Peter Nixdorff		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Lack of Supervision

INVESTIGATION FINDINGS:

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On 9/13/2024, Licensing Program Analyst (LPA) conducted an unannounced visit to delivery the complaint investigation findings. LPA met with Program Director, Peter Nixdorff and explained the purpose of today's visit.

Regarding to the allegation of lack of supervision- the reporting party stated that memory care staff leaves the residents in the lunch hall for an extended periods of time so they don't have to move the residents back and forth from their rooms, and if the residents soiled themselves while waiting, the staff leaves the residents until after lunch to change them. The reporting party also reported that a resident with vision problem isolates him/herself in the room because its the only environment that he/she can navigate independently. In addition, a resident slipped out of the wheelchair while getting fresh air.

As part of the investigation, LPA Han and LPA Tobola interviewed Memory Care Director, facility staff, resident #1(R1), resident #2(R2), and other residents.
Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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-20240731085313

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAGEBROOK SENIOR LIVING AT SAN FRANCISCO	FACILITY NUMBER: 385600423
	VISIT DATE: 09/13/2024

NARRATIVE

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According to the Memory Care Director, there are 2 caregivers and 1 Medication Technician (Med Tech) on the unit for the AM and PM shifts and 2 caregivers and 1 Med Tech on the night shift. The Memory Care Director stated that there should always be a staff in the dining room to supervise the residents and if the residents needed to be change, and/or wanted to go back to their rooms, the caregivers would provide the assistance while the Med Tech stayed in the dining room.

LPAs interviewed the facility staff members who stated there is always someone providing supervision in the dining room. They also stated that they would bring the residents to the bathroom and/or back to their rooms after the meals but if the residents needed to go to the bathroom or to be changed prior to their meals, they would assist the residents. Furthermore, they stated that some residents would walk back and forth from the dining room to the hallway and back and sometimes they would redirect them to stay in the dining room for their meals.

LPA interviewed R1 who slipped out of the wheelchair while getting some fresh air and R1 stated that it was an accident and several staff members helped and responded to the incident right away. R1 also stated that staff members were responsive but sometimes the response time took a longer because they were busy.

LPAs interviewed R2 who stated that due to his/her vision problem, it would be a big challenge in the morning if he/she was assigned to a caregiver who did not know the routines such as an agency staff.

During the interview with R2, LPAs attempted to obtain additional details regarding to being isolated in the room as the reporting party reported, however, R2 did not want to provide any information.

LPAs interviewed the Resident Service Director who was aware of R2's health condition and stated that most of the time, R2 is being assigned to a regular caregiver. However, when there were sick calls, they had to readjust their schedule and get someone from the agency and resulted R2 not being assigned to a regular staff.

Based on documents provided, LPA observed R2 required additional assistance and the Resident Service Director is meeting with R2 on a regular basis to ensure R2's needs are being met.

LPA interviewed other residents and they stated that they liked the facility, and staff members were caring and assisting them with their needs.

After the investigation, this allegation is deemed to be unsubstantiated.

Although the above investigations 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.

This report is reviewed and discussed with the Director.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
07/31/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20240731085313

FACILITY NAME:	SAGEBROOK SENIOR LIVING AT SAN FRANCISCO		FACILITY NUMBER:	385600423
ADMINISTRATOR:	PHOEBIE CARCOT		FACILITY TYPE:	740
ADDRESS:	2750 GEARY BLVD		TELEPHONE:	(415) 346-0246
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	111	CENSUS:	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Program Director, Peter Nixdorff		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Licensee does not ensure the facility has an active administrator on site

INVESTIGATION FINDINGS:

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On 9/13/2024, Licensing Program Analyst (LPA) conducted an unannounced visit to delivery the complaint investigation findings. LPA met with Executive Director, Peter NIxdorff and explained the purpose of today's visit.

Regarding to the allegation of - licensee does not ensure the facility has an active administrator on site, the reporting party stated that the facility has been without an Executive Director for 6 months.

As part of the investigation, LPA Han and LPA Tobola interviewed the facility directors who stated that since the previous administrator left in February 2024, the facility did not have a permanent administrator but there was always an interim administrator.

During the visit on 8/7/2024, LPAs observed that the facility has a certified administrator on site.

Based on the Department's record, the facility has been in communication with CCL and providing documents to update the administrator on file.

After the investigation, this allegation is deemed to be unfounded as the facility did not have a permanent administrator since February 2024, however, the facility has had several interim administrators while hiring a permanent administrator.

The agency has investigated the allegation and we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted. This report was reviewed with the Director and a copy of the report left at the facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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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