385601084-7-10-2023-14-AS-KHOS-CU3HF7-20230725060901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601084
Report Date: 07/10/2023
Date Signed: 07/10/2023 04:06:57 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
07/05/2022 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220705125146

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: 151	DATE:	07/10/2023
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Edwina Tang		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was left in the soiled diaper for extended period of time.
Resident needs not being met.
Facility is short staffed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Based on review of facility's client records--including care plan and care notes--caregivers' schedules from May to July 2022, observations made on 7/8/22 and 6/30/23, and interviews with staff and witnesses, these allegations are determined to be unsubstantiated.

Caregivers are assigned to care for up to 5 memory care clients, and complete a daily assignment form to record personal care--including bathing/showering, dressing/grooming, skin care, toileting, showering, status checks and nutrition--and other comments. At the end of the shift, caregivers log meal intake %, bowel movement, and showers--yes, no, refused--on the client's monthly ADL Report Log. Med techs review the daily assignment forms and identify highlights and/or concerns.
According to staff, client #1 was checked regularly to ensure that his pull-ups were dry. This was in accordance with facility Care Plan, which specified that staff were to check and assist client with toileting needs every 2 hours. Documentation of these checks was not maintained, so there is no record of when or how often staff checked or assisted with toileting. That client wore a soiled diaper for an extended period of time cannot be proven nor disproven.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 14-AS-20220705125146

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: 07/10/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

As per November 2021 care plan for client #1, he was to receive assistance with showers 3 times per week. Upon review of facility's ADL Reports Logs for May, June, July 2022, caregivers assisted client to shower 3 times in May, 6 times in June, and 7 times in July, and he refused to shower at least 4 times. LPA was advised that when client refused to shower, a sponge bath was offered as an alternative, but not documented by staff. It cannot be confirmed that client's needs were not met by staff.
Based on review of memory care units staffing in May, June, July 2022, no staff shortages were apparent. In July 2022, there were 43 clients residing in 4 memory care units/neighborhoods. AM shift averaged 6.57 caregivers in May, 6.58 in June, and 6.93 in July; PM shift averaged 6.64 caregivers in May, 6.23 in June, and 7.2 in July; NOC shift averaged 5.25 caregivers in May, 6.0 in June, and 6.03 in July.

Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur.

SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2