385601097-2-8-2023-14-AS-KHOS-CPAPAG-20230222100842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601097
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:55:16 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
10/25/2022 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20221025152849

FACILITY NAME:	SUTRO HEIGHTS CORPORATION		FACILITY NUMBER:	385601097
ADMINISTRATOR:	PACALDO, JULIET		FACILITY TYPE:	740
ADDRESS:	659 45TH STREET		TELEPHONE:	(415) 571-8531
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY:	14	CENSUS: 12	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Manager, Oscar Madrigal		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Resident left in soiled diaper for an extended amount of time.

INVESTIGATION FINDINGS:

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On 2/8/2023, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings of complaint # 14-AS-20221025152849. LPA met with manager, Oscar Madrigal and explained the purpose to today's visit.

Regarding to allegation of- resident left in soiled diaper for an extended amount of time, there is no additional information forthcoming from the reporting party. However, during the initial reporting, the reporting party stated that during a visit, resident #1 (R1) was in soiled clothing and the reporting party had to change R1.
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The administrator denied the allegation and stated that staff documents on a log whenever care is provided to R1 such as turning and repositioning, providing incontinent care, changing and cleaning R1, etc. and the log is placed in R1's room.

During the initial 10-day visit on 11/3/2022, LPA observed R1 to be cleaned, appeared to be calm and comfortable. In addition, LPA observed a log on R1's bedside table with documentation by staff when care is rendered on a daily basis.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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-20221025152849

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: SUTRO HEIGHTS CORPORATION	FACILITY NUMBER: 385601097
	VISIT DATE: 02/08/2023

NARRATIVE

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According to staff #1 (S1), due to R1's health condition, they check and they anticipate R1's needs several times a day.

According to a nurse from an outside agency who visits R1 on a weekly basis, facility staff keeps R1 clean and comfortable during the visit, he/she has not observed R1 to be soiled and staff assists he/she with caring for R1 whenever is needed.

Based on interviews, observation, and record review during the course of the investigation, this allegation is deemed to be unsubstantiated.

Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

This report is discussed and reviewed with the manager.

A copy is provided.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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