385601084-9-19-2023-14-AS-KHOS-CWVHZL-20231023063830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601084
Report Date: 06/30/2023
Date Signed: 09/19/2023 11:53:11 AM

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
03/07/2023 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230307165826

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: 152	DATE:	06/30/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Edwina Tang, Rob Sarison, Gloria Vo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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- Facility not allowing resident to leave facility

INVESTIGATION FINDINGS:

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Based on review of client and facility records and interviews with staff, witnesses, as well as resident, this allegation is determined to be unsubstantiated.

Nine months after admission, local Ombudsman responded to client's request for assistance to return to her private residence and met with resident and staff. According to staff, client repeatedly expressed her desire to go home, but would be easily redirected. Two months later, in October 2022, DPOA met with staff and Ombudsman to review the appropriateness of client's placement and assess whether or not she was able to go home. Client's home was not suitable to ensure client's safety, and staff planned to further engage client in activities suited for her interests until she could be relocated. The Ombudsman had no concerns that client was forced to remain in facility against her will.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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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Control Number 14-AS-20230307165826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LYNNE & ROY M FRANK RESIDENCES	FACILITY NUMBER: 385601084
	VISIT DATE: 06/30/2023

NARRATIVE

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Following the October meeting, DPOA arranged to have client's private home cleaned and set up for safety. This included sorting through mail, tax and financial documents, unpaid bills, clearing dirty laundry, clothing and clutter, as well as retaining a private care manager and hiring and scheduling 24 hour companions.

Pre-placement appraisal completed prior to client's RCFE admission states that client has poor short-term memory and confusion. Facility's care plan identified that client was disoriented, forgetful and repetitious.
As per MD reports dated 10/27/21--prior to admission--1/31/23, and 2/9/23, client has mild cognitive impairment and prior alcohol dependency. Most recent MD report states that 24 hour monitoring is needed due to intermittent confusion.

Former resident acknowledged that in order for her to return home, she had to be fully able to access and manage the stairs in and outside her private residence. When she recovered from her injury, she expressed her desire to return home, and Ombudsman was instrumental in facilitating this in March 2023, with 24 hour companions. Her personal right to leave facility was not violated and the length of time she lived at facility was not a concern.

Due to client's intermittent confusion, forgetfulness and short-term memory loss, this allegation cannot be determined to be substantiated or unfounded. Although the allegation may have occurred or is valid, there is not enough evidence to prove the alleged violation did or did not occur.

SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC9099 (FAS) - (06/04)

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