385600423-1-8-2025-14-AS-AMEN-DDKT3G-20250204132219

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600423
Report Date: 01/08/2025
Date Signed: 01/08/2025 03:37:30 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
11/20/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20241120150635

FACILITY NAME:	SAGEBROOK SENIOR LIVING AT SAN FRANCISCO		FACILITY NUMBER:	385600423
ADMINISTRATOR:	PETER T. NIXDORFF		FACILITY TYPE:	740
ADDRESS:	2750 GEARY BLVD		TELEPHONE:	(415) 346-0246
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	111	CENSUS: 62	DATE:	01/08/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Peter Nixdorff, Executive Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not maintain a comfortable temperature for residents in care
Facility is in disrepair

INVESTIGATION FINDINGS:

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On 1/8/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Peter NIxdorff (S1). LPA toured the facility, interviewed staff, resident and outside party, reviewed facility records and made observations during the course of the investigation.

Complaint alleges staff did not maintain a comfortable temperature for residents in care after facility heating system had become damaged. Based upon tour of the facility, LPA found that the heating system only allows an "on and off" control with no thermostat to indicate exact temperature. During LPA's multiple facility visits, the facility was found to be at a comfortable temperature and not observed to be cold or signs of residents in discomfort. In addition, the facility had provided additional blankets and individual space heaters to residents affected. Interviews with Maintenance Director (S2) it was found that bedrooms 300, 301, 302 and 304 had been affected by the heating system damages. Upon inspection of bedrooms, LPA found that the heaters in rooms 301 and 302 had been restored to working condition with heaters observed to be on and the bedrooms warm and comfortable.
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: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

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-20241120150635

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: 01/08/2025

NARRATIVE

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Upon inspection of bedrooms 300 and 304, LPA found that the facility is still undergoing repairs. However, LPA observed residents' rooms to be equipped with personal space heaters and additional blankets. LPA was able to interview resident (R1) located in room 300. R1 did not have any concerns or report being cold and stated that they felt fine. R1 was observed on their bed and showed LPA the additional blankets they were using. R1's space heater was off during the inspection but was tested and in working order. In addition both rooms (300 and 304) did not appear to be cold or at a discomforting temperature. LPA contacted San Francisco Ombudsman Officer, (O1) who also confirmed that they had conducted a facility inspection in response to the allegations. O1 indicated that the facility had provided additional blankets and space heaters for resident bedroom still in need of services. O1 also stated that during their visit, they were not able to conduct/determine a temperature reading due to no thermostat. Lastly, O1 reported the facility to have responded appropriately and in a timely manner.

Complaint alleges facility is in disrepair after facility heating system had become damaged. Based upon interviews with staff (S1,S2) it was determined that the facility heating system had become damaged due to the boiler flooding and effecting the heaters. The facility became aware on 11/17/2024 and began repair requests immediately. Interview with Maintenance Director (S2) indicated that service repairs were submitted the following day. LPA was provided the invoice for the first repair service to the boiler. In addition, residents who's bedrooms were affected and had no working heater, were provided additional blankets and portable space heaters to accommodate while the facility repairs were in place. LPA was informed by Maintenance Director (S2) that the bedrooms 300, 301, 302 and 304 had been affected by the heating system damages. Upon inspection of bedrooms, LPA found that the heaters in rooms 301 and 302 had been restored to working condition with heaters observed to be on and the bedrooms warm and comfortable. Upon inspection of bedrooms 300 and 304, LPA found that the facility is still undergoing repairs with the remaining two bedroom heaters, but had provided appropriate accommodations. Although the facility had undergone damages to the heating system, LPA found that the facility had responded appropriately and timely in order to have the system restored. Due to contradicting information gathered during the course of the investigation the allegation is found to be unsubstantiated.

A finding that the complaint allegations, staff did not maintain a comfortable temperature for residents in care and facility is in disrepair are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
No deficiencies cited.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC9099 (FAS) - (06/04)

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