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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385601097
Report Date: 07/18/2024
Date Signed: 07/25/2024 07:31:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
09/08/2023 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230908153602
FACILITY NAME:SUTRO HEIGHTS CORPORATIONFACILITY NUMBER:
385601097
ADMINISTRATOR:PACALDO, JULIETFACILITY TYPE:
740
ADDRESS:659 45TH STREETTELEPHONE:
(415) 571-8531
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:14CENSUS: 8DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Shirley Aguado and Julio YapTIME COMPLETED:
07:45 PM
ALLEGATION(S):
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- Resident's call button is not answered in a timely manner by facility staff
- Client file is not maintained
- Client did not receive medications as prescribed



INVESTIGATION FINDINGS:
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Based on LPA Jeung's observations on 9/13/23--as well as information from witnesses--these allegations are substantiated. The preponderance of evidence standard has been met.

During facility inspection on 9/13/23, emergency call system was not installed in 3 out of 5 client rooms on ground level. This included the room where former client #1 was residing in room #7. On 9/1/23, client #1 was alleged to have fallen at 2am and called out for staff assistance, as there was no emergency call button. Client waited for over an hour until male staff responded and helped client to get up from the floor.
****Type A Deficiency citation was issued on 9/13/23. See Facility Evaluation Report*****

As noted on Facility Evaluation Report on 9/13/23, there is no client file maintained for client #2, who shares second floor room #3 with client #1. Client #2 was admitted on 9/1/23.
Continued on next page.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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-20230908153602
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SUTRO HEIGHTS CORPORATION
FACILITY NUMBER: 385601097
VISIT DATE: 07/18/2024
NARRATIVE
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Continuation:

Client #1 was admitted on 8/31/23 after 5pm, but it cannot be confirmed that medications were brought to facility upon admission. On 9/13/23, LPA observed Rx medications for 18 days (almost 3 weeks) in bubblepacks. Of the 18 days of Rx medications observed in bubblepacks, it appears that client was given medications for 6 out of the 12 full days that client has been a resident. Client #1 reports that she was not given medications for the first 3 days; on the 4th day, staff gave her medications. It is observed that daily doses of pills are contained in bubblepacks printed with dates and times; however, some medications for future dates are missing, so staff are not giving medications on the dates indicated on bubblepacks.

Deficiencies of the California Code of REgulations, Title 22 are cited on a following page.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 14-AS-20230908153602
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SUTRO HEIGHTS CORPORATION
FACILITY NUMBER: 385601097
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/26/2024
Section Cited
CCR
87465(a)(4)
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87465(a)(4) INCIDENTAL MEDICAL CARE
The licensee shall assist residents with self-administered medications as needed.
This requirement was not met, as client #1 was not provided with Rx medications for first 3 days of admission on 8/31/23.
Licensee failed to ensure that clients are
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Plan of correction to be submitted to CCLD BY DUE DATE
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given medications as prescribed by MD, which poses an immediate health, safety or personal rights risk to clients in care.
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Type A
07/26/2024
Section Cited
CCR
87506(a)
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87506(a) RESIDENT RECORDS
The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
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Plan of correction shall be sent to CCLD BY DUE DATE, and shall include how this will be avoided in future.
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This requirement was not met, as facility had not maintained a file for client #2 during initial complaint visit on 9/13/23. Licensee failed to maintain a current record for client #2, who was admitted on 9/1/23, This posed an immediate health, safety, or personal rights risk to client 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.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
09/08/2023 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230908153602

FACILITY NAME:SUTRO HEIGHTS CORPORATIONFACILITY NUMBER:
385601097
ADMINISTRATOR:PACALDO, JULIETFACILITY TYPE:
740
ADDRESS:659 45TH STREETTELEPHONE:
(415) 571-8531
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:14CENSUS: 8DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Shirley Aguado and Julio YapTIME COMPLETED:
07:45 PM
ALLEGATION(S):
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- Resident was left on the floor unattended for an extended period of time
- Staff do not ensure facility is free from hazards
- Resident in care was not provided a proper mattress
- Staff do not ensure resident's hygiene needs are properly met
INVESTIGATION FINDINGS:
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Based on LPA's observations on 9/13/23 during initial complaint visit and interviews with client and 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.

Client #1 was admitted on 8/31/23 and fell that first night. It is alleged that staff did not respond to client's calls for help for over an hour. Staff who finally responded was not interviewed and is no longer employed.

During LPA's initial complaint visit on 9/13/23, no tripping hazards were observed. Client rooms were accessible and allowed easy access in and around bedrooms.

On 9/13/23, client #1 told LPA Jeung that the mattress she sleeps on in 2nd floor room is fine. Initially, she complained that it was too high. Complaint alleges that the air mattress was too soft, as it was not inflated enough.
Continued on next page
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 14-AS-20230908153602
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SUTRO HEIGHTS CORPORATION
FACILITY NUMBER: 385601097
VISIT DATE: 07/18/2024
NARRATIVE
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It cannot be determined if the hygiene needs of client #3 were met by staff. LPA observed client during initial complaint visit on 9/13/23 and did not detect that staff neglected her hygiene needs. Client was discharged in November 2023.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5