385601084-5-12-2023-14-AS-JJIN-CT2NNT-20230622103714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601084
Report Date: 05/12/2023
Date Signed: 05/12/2023 12:20:32 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
03/23/2022 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220323142722

FACILITY NAME:	LYNNE & ROY M FRANK RESIDENCES		FACILITY NUMBER:	385601084
ADMINISTRATOR:	TANG, EDWINA		FACILITY TYPE:	740
ADDRESS:	ONE AVALON AVENUE		TELEPHONE:	(415) 562-2855
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	220	CENSUS:	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Edwina Tang		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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- Resident was physically attacked by another resident
- Staff did not provide food of the quality or quantity to meet needs of residents
- Staff did not meet resident's incontinence needs
- Staff did not meet resident's hygiene needs
- Resident's room is not properly cleaned by staff

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) conducted an unannounced complaint investigation visit in order to deliver the findings for the above allegations. LPA met with executive director Edwina Tang and assistant executive director Robert Sarison. LPA explained the purpose of today's visit.

During the course of the investigation LPA conducted interviews with staff, made facility observations, interviewed resident family members, outside agencies, and reviewed pertinent documents. LPA could not reach a preponderance of evidence standard to substantiate any of the allegations received as conflicting information and one party's word over another, could not aid in the determination of any of the allegations. These allegations are unsubstantiated.

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 reveiwed with executive director Edwina Tang.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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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