385601133-8-7-2024-14-AS-KHOS-D8RJC2-20240903065513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601133
Report Date: 08/07/2024
Date Signed: 08/07/2024 06:57:56 PM

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
11/02/2023 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20231102153914

FACILITY NAME:	VICTORIA'S HOUSE		FACILITY NUMBER:	385601133
ADMINISTRATOR:	WILLIAMS,DARNELL		FACILITY TYPE:	735
ADDRESS:	658-666 SHOTWELL ST		TELEPHONE:	(747) 215-2500
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	46	CENSUS: 36	DATE:	08/07/2024
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Darnell Williams		TIME COMPLETED:	07:00 PM

ALLEGATION(S):

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- Staff are not ensuring resident’s medication is being administered as prescribed

- Staff are discontinuing medical care without authorization from resident's authorized representative

INVESTIGATION FINDINGS:

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Based on review of client records--including Centrally Stored Medications Records and Medication Administration Records--and information from public conservator, 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 is conserved, and care is managed by public conservator and medical providers. Facility staff administer medications prescribed by medical providers, and maintain a record of medications administered, which is not required by Title 22. A record of centrally stored medications is maintained as required.
Client was prescribed medications by more than one medical provider, and medications were also discontinued by more than one medical provider.

Based on this information, it cannot be determined that resident's medications were not being administered correctly, nor that discontinuation of medications was done without approval from an authorized representative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

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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