385600429-3-27-2021-14-AS-KHOS-BZLQ43-20210330114941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600429
Report Date: 03/26/2021
Date Signed: 03/27/2021 11:39:06 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/17/2021 and conducted by Evaluator Mohamed Filouane

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20210217081812

FACILITY NAME:	COVENTRY PLACE		FACILITY NUMBER:	385600429
ADMINISTRATOR:	MARK NITSCHE		FACILITY TYPE:	740
ADDRESS:	1550 SUTTER STREET		TELEPHONE:	(415) 921-1552
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	210	CENSUS: 160	DATE:	03/26/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Mark Nitsche		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff did not seek psychiatric help for resident.
Medical technicians not properly trained to assist residents with medication.
Medication errors not reported to licensing.
Facility is in disrepair.

INVESTIGATION FINDINGS:

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On 3/17/21, Licensing Program Analysts (LPAs) Mohamed Filouane and Murial Han conducted a follow-up complaint inspection with the Facility Director (FD), Mark Nitsche, over the phone. Due to COVID-19 and health and safety concerns, LPA was not present in the facility. LPA spoke with the home operator, explained the purpose of the phone call, and then delivered the findings.

Concerning the allegation of facility staff not seeking psychiatric help for a resident, LPA Filouane investigated, interviewed the Facility Director, the Eliven Director, and the resident's conservator. Interviews with facility directors revealed that the resident is doing well. In an interview the with resident's conservator, LPA Filouane asked if the resident required psychiatric help. The conservator stated the resident did not and does not require psychiatric help and that the resident can get dramatic at times, especially around and in the month of December due to resurfacing memories. When LPA questioned the facility's care of the resident, the conservator stated and confirmed that they have no concerns, that the facility is doing their job and is responsive in caring for the resident. After evaluation, this allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Mohamed Filouane	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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-20210217081812

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COVENTRY PLACE	FACILITY NUMBER: 385600429
	VISIT DATE: 03/26/2021

NARRATIVE

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Concerning the allegation of medical technicians not properly trained to assist residents with medication, LPA Filouane interviewed the Facility Director, Enliven Director, requested and reviewed training records for medical technicians. The Facility Director stated in an interview with the LPA that no staff member was in orientation training. LPA reviewed the training records of the medical technicians and observed that the medical technicians are properly trained to assist residents with medication. After evaluation, this allegation is unsubstantiated.

Concerning the allegation of medication errors not reported to licensing, LPA Filouane and LPA Han interviewed the Facility Director and Enliven Director regarding any reports of medication errors submitted by facility staff. The FD stated in an interview that they had not received any medication error reports. In an interview with the LPAs, the Enliven Director also stated they had not received reports of medication errors from facility staff. LPAs reviewed the medication records of the resident in question and did not find medication errors to substantiate this allegation. LPAs also interviewed staff members at the facility who handle medication. Staff members explained to the LPAs in interviews that there have been no medication errors to report. Additionally, the alleged medication errors were reported to have happened in the Memory Care unit of the facility; the residents are unable to attest with clear memory if any medication was, in fact, handled in error. The investigation did not reveal physical evidence of medication errors. After evaluation, this allegation is unsubstantiated.

Concerning the allegation of the facility being in disrepair, LPA Filouane and LPA Han interviewed the Facility Director, the Enliven Director, facility staff members, and staff from the local ombudsman care services. The facility directors both denied the allegation of disrepair in the facility. As reported by the facility directors, there is one washer that requires repair. The facility does have industrial machines in the basement to continue cleaning clothes. In an interview with staff from the local ombudsman services, LPA Filouane asked if the facility was, indeed, in disrepair. The local ombudsman services staff denied the allegation and stated the facility is in good shape. In interviews with the LPAs, facility staff members did not report disrepair in the facility.

Although the allegations 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 allegations are UNSUBSTANTIATED.

Exit interview conducted with the Facility Director over the phone. The Facility Director will receive this LIC9099 report through email or mail to sign and then will email or mail the signed version back to the LPA.

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Mohamed Filouane	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

LIC9099 (FAS) - (06/04)

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