385601116-8-23-2023-14-AS-KHOS-CVKGME-20230911052745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601116
Report Date: 08/23/2023
Date Signed: 08/23/2023 12:07:50 PM

Unfounded

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
08/18/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230818081109

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: 114	DATE:	08/23/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Shirley Cheung and Deborah Suarez		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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- Staff did not comply with infection control practices resulting in a H&S risk

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigaiton visit to investigate the allegation received. LPA met with Shirley Cheung who is the resident care director initially then later LPA met with assistant general manager Deborah Suarez and explained the purpose of today's visit.

During today's visit LPA discussed the allegation with both staff persons Shirley and Deborah. Infection control plans are discussed and confirmed as being in place. Facility has reported the cases to San Francisco Department of Public Health (DPH) regularly since the first positive discovered on 08/18/2023 up to today. DPH has provided the facility with additional guidance at this time which is provided to LPA. LPA toured the memory care where COVID cases are isolated to in order to observe infection control protocols being in place which they are.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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-20230818081109

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: COTERIE CATHEDRAL HILL	FACILITY NUMBER: 385601116
	VISIT DATE: 08/23/2023

NARRATIVE

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Page 2 - LIC9099

Positive residents are isolated in their rooms and visitation guidelines are in place requiring visitors to wear N95 masks and face shields if visiting. Staff members in memory care are observed wearing N95 masks and face shields during tour. Notifications to family members are going out on this day due to DPH outbreak status being declared. No staff have tested positive at this time. Facility is abiding by current Provider Information Notification updates at this time. This allegation is unfounded.

This agency has investigated the complaint alleging, Staff did not comply with infection control practices resulting in a H&S risk. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

No citations issued. Report is reviewed with Deborah Suarez.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC9099 (FAS) - (06/04)

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