385601148-12-10-2024-14-AS-KHOS-DC2KAN-20241217064413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601148
Report Date: 12/10/2024
Date Signed: 12/10/2024 12:48:19 PM

Unfounded

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
09/17/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20240917181205

FACILITY NAME:	IVY AT GOLDEN GATE, THE		FACILITY NUMBER:	385601148
ADMINISTRATOR:	RAUKHMAN, KATHERINE		FACILITY TYPE:	740
ADDRESS:	1601 19TH AVENUE		TELEPHONE:	(415) 664-6264
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY:	168	CENSUS: 125	DATE:	12/10/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Katherine Raukhman, Executive Director		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Facility did not issue a refund

INVESTIGATION FINDINGS:

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On 12/10/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced visit for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Katherine Raukhman. LPA interviewed staff, outside parties, reviewed resident records and made observations during the course of the investigation.

Complaint alleges facility did not issue a refund to residents (R1 & R2). Reporting party claims that a refund of all expenses paid to the facility, including community move-in fees and first month rent should be owed to R1 & R2. Based upon interviews with staff (S1) and outside party (I1), it was confirmed that residents R1 & R2 had signed an admissions agreement with an effective date of 7/31/2024. Upon review of records, LPA found that In the admission agreement, it is stated that 100% of the community fee will be refunded if residents decide to withdraw prior to assessment and signing agreement. LPA however found that the facility had conducted a pre-appraisal assessment for both R1 (7/27/2024) and R2 (7/31/2024), prior to or on same date of the signed effective admissions agreement.
Continued onto LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

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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Control Number 14-AS-20240917181205

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: IVY AT GOLDEN GATE, THE	FACILITY NUMBER: 385601148
	VISIT DATE: 12/10/2024

NARRATIVE

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Reporting Party claims that all expenses are owed to residents (R1 & R2) because neither resident had not physically moved into the facility. Based upon interviews with staff (S1) and outside parties (I1,I2), LPA found that R1 & R2 had a signed effective agreement and were able to move into the facility as of 7/31/2024. However, it was found that R1 & R2 voluntarily refused to move their belongings into the facility from their personal home with said effective agreement and paid community and rent fees.

Lastly, document review also indicated that R1 & R2 had submitted a withdrawal letter dated 8/30/2024 to the facility however was unsigned. A second letter was submitted to the facility dated 9/2/2024 declared an outside party (I1) as residents' (R1 & R2) authorized representative. A final letter from I1 dated 9/6/2024, requested a full refund of fees. Although LPA found that the facility received inconsistent documentation for withdrawal, a request was initially submitted by residents' (R1 & R2) within the first month of rent. Again it is indicated on the signed admissions agreement, that R1 & R2 had agreed to facility admission, effective 7/31/2024 and are not owed the alleged amount. In consideration to time frame of withdrawals, the facility was found to have provided the appropriate pro-rated community fees refund amount to residents (R1 & R2).
The agency has investigated the allegation and 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.

No deficiencies cited during today's visit.

SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

LIC9099 (FAS) - (06/04)

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