385601097-12-27-2021-14-AS-KHOS-CAEPRX-20220106103327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601097
Report Date: 12/27/2021
Date Signed: 12/27/2021 12:19:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/20/2021 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20211220125424

FACILITY NAME:	SUTRO HEIGHTS CORPORATION		FACILITY NUMBER:	385601097
ADMINISTRATOR:	PACALDO, JULIET		FACILITY TYPE:	740
ADDRESS:	659 45TH STREET		TELEPHONE:	(650) 393-0265
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY:	14	CENSUS: 13	DATE:	12/27/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	House Manager, Gem Arceo		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility floors are not being cleaned in an odorless cleaner

INVESTIGATION FINDINGS:

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On 12/27/2021, Licensing Program Analyst (LPA) Murial Han conducted an unannounced 10-day initial inspection. LPA Han met with the House Manager, Gem Arceo and explained the purpose of the visit.

Regarding to the facility floors are not being cleaned in an odorless cleaner, the reporting party stated that the facility used a floor cleaner that contains bleach which was toxic to smell and the facility stopped using it in the reporting party's room after the reporting parting spoke to the facility staff. However, the facility continued to use it thought-out the facility which created a strong, and pungent smell.

During the investigation, LPA Han toured the upper and the lower level of the facility. LPA Han did not observe any strong odor in upper level. However, LPA observed a strong odor in the lower level hallway and in the bathrooms. In addition, there was no air circulation devices to minimize the odor. According to the facility staff, the odor was from the cleaning solution(s) that the facility used to clean the floor and the bathrooms downstairs and the staff who was responsible to perform these tasks did not dilute the solution with an appropriate amount of water which created the strong odor.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021

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-20211220125424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SUTRO HEIGHTS CORPORATION	FACILITY NUMBER: 385601097
	VISIT DATE: 12/27/2021

NARRATIVE

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LPA Han interviewed the residents regarding to the smell from the cleaning solution(s) and some of them stated that they noticed the smell but it did not bother them but one of them stated the smell was there on a daily basis when the facility cleaned the floor and it was strong and unpleasant.

Based on interviews and observation during the investigation, the preponderance of evidence standard has been met. Therefore, this allegations were determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with the House Manager, and Appeal Rights provided

This report is discussed and reviewed with the house manager. a copy is provided.

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021

LIC9099 (FAS) - (06/04)

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Control Number 14-AS-20211220125424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SUTRO HEIGHTS CORPORATION	FACILITY NUMBER: 385601097
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/10/2022 Section Cited CCR 87468.1	1 2 3 4 5 6 7	PERSONAL RIGHTS OF RESIDENT IN ALL FACILITIES:(a) Residents in all residential care facilities..shall have following personal rights:(2)To be accorded... healthful and comfortable accommodations..and equipment.	1 2 3 4 5 6 7	The Administrator and/or designee will reeducate the staff regarding the proper mixture of the water and the cleaning solution . The Administrator and/or designee will monitor the smell from the solution. If the smell contines to be pungent and unpleansant to the resident(s), the facility shall replace the items to odorless solutions. The Administrator and/or designee will place devices in the
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA Han observed a strong, and pungent smell in the lower level which was caused by the cleaning solution and according the resident, the smell was strong and unpleasant which posed potential health and safety risks to resident in care.	8 9 10 11 12 13 14	lower level of the facility to create a better air circulation. The Administrator will submit proof(s) to the Regional Office of the education, all the cleaning solutions that will be used after the assessment and the picture(s) of the device(s) that will be used to increase the air circulation by the plan of correction due date 1/10/2022.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021

LIC9099 (FAS) - (06/04)

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