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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385601116
Report Date: 05/24/2024
Date Signed: 05/24/2024 11:51:00 AM

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
12/14/2023 and conducted by Evaluator John Calandra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20231214102829
FACILITY NAME:COTERIE CATHEDRAL HILLFACILITY NUMBER:
385601116
ADMINISTRATOR:LALOYAN,SIRUN SARAHFACILITY TYPE:
740
ADDRESS:1001 VAN NESS AVENUETELEPHONE:
(415) 915-6615
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:260CENSUS: 144DATE:
05/24/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Matt Turner, General Manager TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Due to lack of staffing, resident calls bells are not answered timely
INVESTIGATION FINDINGS:
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On May 24, 2024 at 9:00 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to deliver conclusionary findings for a complaint received on December 14, 2023. LPA Calandra was greeted by Matthew Turner, General Manager and explained the purpose of the visit. Assistant General Manager, Deborah Suarez arrived later during the visit. LPA gathered information relevant to the above complaint allegation and conducted interviews. Regarding the allegation that due to a lack in staffing, resident call bells are not responded to in a timely manner, it was found that there were multiple occasions in which resident call buttons were not responded to in a timely manner. Staff have failed to do this based on information gathered.

The Department has investigated the complaint allegation of a possible violation of a resident’s personal rights. We have found that the complaint allegation is substantiated. Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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 3
Control Number 14-AS-20231214102829
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: COTERIE CATHEDRAL HILL
FACILITY NUMBER: 385601116
VISIT DATE: 05/24/2024
NARRATIVE
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The deficiency cited on the following page is in violation of the California Code of Regulations, Title 22, Division 6, Chapter 8:

This report is provided and reviewed with facility representative and a copy of this report must be made available for public review upon request.

Appeal rights discussed and provided.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20231214102829
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: COTERIE CATHEDRAL HILL
FACILITY NUMBER: 385601116
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
06/10/2024
Section Cited
CCR
87468.1(a)(2)
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87468.1(a)(2): Personal Rights: Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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Licensee/Administrator to submit proof of correction and a written plan outlining how this violation will be avoided in the future to licensing office by due date.
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This requirement was not met in 3 out 3 cases in which staff did not respond to a resident's call button in a timely manner. This is a potential health and/or safety risk to persons 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: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3