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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385601084
Report Date: 03/25/2024
Date Signed: 03/25/2024 01:45:53 PM

Substantiated


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
07/11/2023 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230711162135
FACILITY NAME:LYNNE & ROY M FRANK RESIDENCESFACILITY NUMBER:
385601084
ADMINISTRATOR:TANG, EDWINAFACILITY TYPE:
740
ADDRESS:ONE AVALON AVENUETELEPHONE:
(415) 562-2855
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:220CENSUS: 160DATE:
03/25/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Edwina Tang and Rob SarisonTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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- Licensee neglect resulted in resident developing pressure injuries
- Staff did not report pressure injuries to resident's responsible party
- Staff not properly trained in dementia care
INVESTIGATION FINDINGS:
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LPA Jeung reviewed staff training records.
Based on review of facility records--including Clinical Notes, Care Plan, ADL Report Logs, correspondence and staff training transcripts--as well as interviews with staff, these allegations are determined to be substantiated. The preponderance of evidence standard has been met.

On May 2, 2023--ten days after testing positive for COVID and isolating in his room--client #1 was observed by caregiver with pressure injuries. Two pressure injuries on the coccyx were subsequently observed by visiting family member two days later and reported to facility staff the following day. Client's physician was immediately consulted when assistant director of health and wellness became aware of the injuries, and a plan of care was implemented for the stage I and stage II pressure ulcers, including home health nursing. Earlier observation by staff during assistance with personal care could have resulted in more timely medical intervention. According to visiting nurse assessments, the wounds healed within 6 weeks.

......Continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
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 5
Control Number 14-AS-20230711162135
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2024
Section Cited
CCR
87466
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OBSERVATION OF THE RESIDENT
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs... the licensee shall ensure that such changes
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Plan of correction to be submitted to CCLD BY DUE DATE
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 are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met, as client #1 did not receive timely medical intervention when pressure ulcers were observed, which poses a potential health, safety or personal rights risk to clients.
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Type B
04/08/2024
Section Cited
CCR
87468.1(a)(8)
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PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES
Residents in all RCFEs shall have...the following personal rights:
To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to
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Plan of correction to be submitted to CCLD BY DUE DATE
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their needs. This requirement was not met, as responsible parties of client #1 were not notified when staff observed pressure injuries on client #1. Licensee failed to ensure that responsible parties of client #1 received timely report that pressure injuries were observed, which posed a potential health, safety or personal rights risk to clients.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 14-AS-20230711162135
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: 03/25/2024
NARRATIVE
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Staff training records for 3 caregivers in memory care unit 3 are reviewed today. This does not include one agency staff, for which there is no information about what dementia training was received.
Two staff were required to have at least 12 hours of dementia specific training, as part of initial training. One caregiver was required to have at least 8 hours of dementia specific training, as part of annual continuing training.
There is no documentation to verify that two new staff received 12 hours of dementia specific training, and there was documentation of just 5.5 hours of annual continuing dementia training for one caregiver.

Deficiencies of the California Code of Regulations, Title 22 are cited on a following page.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 14-AS-20230711162135
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2024
Section Cited
HSC
1569.625(b)(1)
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This training shall consist of 40 hours... A staff member shall complete 20 hours, including 6 hours specific to dementia care, as required by subdivision (a) of Section 1569.626 ...before working independently with residents. The remaining 20 hours shall include 6 specific to dementia care and shall
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Plan of correction to be submitted to CCLD BY DUE DATE
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be completed within the first four weeks of employment. This requirement was not met, as there is no evidence that staff #2 and #3--who were hired 4/23 and 12/22 respectively--received at least 12 hours of dementia specific training, which posed a potential health, safety or personal rights risk to clients.
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Type B
04/08/2024
Section Cited
HSC
1569.625(b)(2)
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...training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626...
This requirement was not met, as there is no documentation that staff #1, who was
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Plan of correction to be submitted to CCLD BY DUE DATE
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hired 5/22, received at least 8 hours of dementia specific training. Licensee failed to ensure that staff received required annual dementia training, which posed a potential health, safety, or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
07/11/2023 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230711162135

FACILITY NAME:LYNNE & ROY M FRANK RESIDENCESFACILITY NUMBER:
385601084
ADMINISTRATOR:TANG, EDWINAFACILITY TYPE:
740
ADDRESS:ONE AVALON AVENUETELEPHONE:
(415) 562-2855
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:220CENSUS: 160DATE:
03/25/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Edwina Tang and Rob SarisonTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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- Staff do not ensure resident is bathed
- Staff do not assist resident with grooming
INVESTIGATION FINDINGS:
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Based on review of facility records--including Clinical Notes, Care Plan, and ADL Report Logs--and interviews with staff, these allegations are determined to be unsubstantiated.
Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur.

As per Care Plan for client #1, staff are to assist him with toiletting, incontinence care, daily grooming and dressing, showering/bathing 3x/week. According to ADL Report Logs for May, June, July 2023, caregivers assisted client to shower or provided sponge bathing 16 times in May, 15 times in June, and 6 times from July 1st to July 18th, 2023. Client resides in memory care unit 3 consisting of 2 neighborhoods of 11 rooms and 19 rooms. It cannot be confirmed that staff failed to assist client to be showered, bathed or groomed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5