385601045-9-29-2023-14-AS-KHOS-CWFMJG-20231009093906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601045
Report Date: 09/29/2023
Date Signed: 09/29/2023 12:51:27 PM

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
03/27/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230327163312

FACILITY NAME:	PORTOLA GARDENS		FACILITY NUMBER:	385601045
ADMINISTRATOR:	JEFFREY DILLON		FACILITY TYPE:	740
ADDRESS:	350 UNIVERSITY ST		TELEPHONE:	(415) 337-1587
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94134
CAPACITY:	132	CENSUS: 72	DATE:	09/29/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lea Salazar - Administrative Assistant		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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- Staff did not ensure a resident consumed an appropriate amount of fluids while in care
- Staff did not ensure the residents were properly fed while in care
- Staff did not meet the residents hygiene needs
- Staff did not address a resident's change in medical condition
- Staff did not follow infection control procedures

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to investigate the allegations received and deliver findings on the allegations. LPA met with administrator assistant Lea Salazar and explained the purpose of today's visit.

During the course of the investigation interviews were conducted, pertinent resident documents are reviewed, and facility observations are made. It is discovered that there is contradicting information in regards to the allegations received versus what the facility was able to provide via interviews, observations made, and documentation. LPA is unable to prove whether the allegations took place or not due to the conflicting information.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations 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 above allegations are unsubstantiated at this time. Report is reviewed with Lea Salazar.

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: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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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