385601116-10-31-2023-14-AS-KHOS-CY2KJ3-20231129065603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601116
Report Date: 10/31/2023
Date Signed: 10/31/2023 10:44:37 AM

Unsubstantiated

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
07/25/2023 and conducted by Evaluator John Calandra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230725122257

FACILITY NAME:	COTERIE CATHEDRAL HILL		FACILITY NUMBER:	385601116
ADMINISTRATOR:	LALOYAN,SIRUN SARAH		FACILITY TYPE:	740
ADDRESS:	1001 VAN NESS AVENUE		TELEPHONE:	(415) 915-6615
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	260	CENSUS: 125	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Shirley Cheung, Care Coordination Director and Deborah Suarez, Assistant General Manager		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Licensee does not ensure the facility has sufficient staff to meet the care needs of residents

INVESTIGATION FINDINGS:

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

On this day Licensing Program Analysts (LPA) John Calandra, Grace Donato, and Licensing Program Manager(LPM) April Cowan conducted an unannounced complaint investigation visit in order to deliver the findings regarding the allegation received. The LPAs and LPM met with Shirley Cheung, Care Coordination Director(CCD) and Deborah Suarez, Assistant General Manager(AGM) and explained the purpose of today's visit.

During LPA Jaime Vado's investigation on October 10, 2023, the LPA conducted interviews, reviewed pertinent documents, and made observations of the memory care unit. LPA Vado could not identify any staff shortages per observations made. The facility scheduling shows staffing is in place and demonstrated they are able to meet the needs of residents. This allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Report reviewed with Shirley Cheung, CCD and Deborah Suarez. A copy of the report was left at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

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 3