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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385610003
Report Date: 09/20/2023
Date Signed: 09/20/2023 11:57:17 AM

Unsubstantiated


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
06/01/2023 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230601141558
FACILITY NAME:SAN FRANCISCO INTERNATIONAL FACILITY (A)FACILITY NUMBER:
385610003
ADMINISTRATOR:JAMIEL/BRENDA LEMLEYFACILITY TYPE:
735
ADDRESS:1226 GOETTINGEN STREETTELEPHONE:
(415) 467-8896
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:6CENSUS: 4DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Brenda LemleyTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff treat resident differently than other residents in the facility
Staff does not allow resident to bring new clothes they purchased into the facility.
Staff does not allow resident to bring food they purchased into the facility.
Staff does not allow resident to carry a legal form of ID.
Staff does not allow resident to have private phone conversations at the facility.
Staff hit resident in care
INVESTIGATION FINDINGS:
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On September 20, 2023, Licensing Program Analyst (LPA), Murial Han conducted an unannounced visit to deliver the complaint investigation findings. LPA met with administrator and explained the purpose of the visit.

Regarding to allegation of staff treat resident differently than other residents in the facility, there is no additional information forthcoming from the reporting party and resident-in-question (R1). However, during the initial reporting, R1 stated that the administrator no longer wanted R1 living in the home result R1 of feeling being treated differently.

The administrator denied the allegation and stated that R1 has been at the facility for many years and they have treated R1 and other residents equally. The administrator stated that before the pandemic, they brought all the residents on vacation, brought them clothes, food, provided them with transportation, ensured their safety, etc.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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 6
Control Number 14-AS-20230601141558
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: SAN FRANCISCO INTERNATIONAL FACILITY (A)
FACILITY NUMBER: 385610003
VISIT DATE: 09/20/2023
NARRATIVE
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As part of the investigation, LPA interviewed 2 family members and GGRC social worker and all of them reported that they have not witnessed or noticed facility administrators and staff favored one resident over another resident.

After the investigation, this allegation is deemed to be unsubstantiated.

Regarding to staff does not allow resident to bring new clothes they purchased into the facility, there is no additional information forthcoming from the reporting party and resident-in-question (R1).

LPA interviewed the administrators and both of them denied the allegation. One of them stated that this allegation was a misunderstanding. R1 had purchased some clothes but after trying them on, R1 did not like it so the administrator suggested R1 to bring it with R1 on the following day to the day program so R1 could return or exchange the items afterwards. However, the day program staff interrupted it as the facility did not allow R1 to bring new clothes to the facility.

In addition, the administrator stated that they always made sure all the residents looked nice, cleaned and tidy. They even brought them new clothes when they took them on a vacation a couple of years ago.

LPA interviewed GGRC SW who has 2 residents residing at the facility and the GGRC SW did not encountered any concerns regarding to residents bringing new clothes to the facility.

In addition, LPA interviewed 2 responsible parties and both of them stated that the administrator always made sure their loved ones looked good, and cleaned and they have never been discouraged from bringing new clothes to the facility for their loved ones. In addition, one of them validated that the administrator purchased new clothes for their loved ones during the most recent vacation to another country.

After the investigation, this allegation is deemed to be unsubstantiated.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 14-AS-20230601141558
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: SAN FRANCISCO INTERNATIONAL FACILITY (A)
FACILITY NUMBER: 385610003
VISIT DATE: 09/20/2023
NARRATIVE
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Regarding to allegation of staff does not allow resident to bring food they purchased into the facility, there is no additional information forthcoming from the reporting party and R1.

According to the administrator, they allowed family members and residents to bring food to the facility as they wish. The administrator stated that R1 has always purchased snacks, and brought them back to the facility and ate it while watching TV. In addition, the administrator stated that R1's family brought food for R1 during holidays and special events, and staff would prepare it and gave it to R1 right away or during meal times.

LPA interviewed 2 family members and both of them reported that they have brought food to the facility for their loved ones and they have not been discouraged by the administrator not to do so.

After the investigation, this allegation is deemed to be unsubstantiated.

Regarding to the allegation of staff does not allow resident to carry a legal form of ID, there is no additional information forthcoming from the reporting party and R1. However, during the initial reporting, R1 stated that he/she was not allowed to carry an original legal California Identification for banking instead R1 was given a copy of it.

The administrator denied the allegation and stated that residents have a copy of their identification card on them but not the original. The administrator explained that the crime rate in San Francisco is rising everyday and the facility is located in a not so ideal neighborhood so to ensure the safety of the residents, the administrator provided them with a copy of their identification card. However, if they needed the original, it was kept in their individual files and will be provided right away.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 14-AS-20230601141558
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: SAN FRANCISCO INTERNATIONAL FACILITY (A)
FACILITY NUMBER: 385610003
VISIT DATE: 09/20/2023
NARRATIVE
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During LPA's visit, LPA observed resident's identification cards are kept in their files.

LPA interviewed a responsible party who stated that he/she was aware that the facility provided a copy of the identification card to the residents instead of the original and the responsible party has not encountered any problems with facility staff when the original card was needed.

After the investigation this allegation is deemed unsubstantiated.

Regarding to the allegation of staff does not allow resident to have private phone conversations at the facility, there is no additional information forthcoming from the reporting party and R1. However, during the initial reporting, the reporting party stated that R1 cries every time a social worker talked to R1 on the phone and all the phone calls were done at the day program and not the facility.

The administrator denied the allegation and stated that R1 used the house phone and talked in his/her room.

LPA interviewed 2 family members and both of them reported that their loved ones were able to conduct private phone calls whenever they wanted to.

After the investigation, this allegation is deemed to be unsubstantiated.

Regarding to allegation of- staff hit resident in care, the reporting party stated that a State Official reported that R1 reported to the State Official that a caregiver slapped R1 on the face and hit R1's head during shower.

On 6/2/2023, R1 also reported the above allegation to his/her sister and the sister observed a "lump" and a "bruise" on R1's head, therefore, the sister took R1 to the hospital on the same day for further evaluation.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 14-AS-20230601141558
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: SAN FRANCISCO INTERNATIONAL FACILITY (A)
FACILITY NUMBER: 385610003
VISIT DATE: 09/20/2023
NARRATIVE
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LPA interviewed the administrators who denied the allegation and stated that on 6/1/2023, when R1 returned from work, R1 reported fallen at work, hitting R1's head and complained of a headache. The administrator did not see any visible injuries but took R1 to the hospital for further evaluation and R1 returned on the same day.

Based on the hospital discharge summary, R1's discharge diagnosis was headache and there was no indication of a "lump" and a "bruise" on R1's head.

On 6/2/2023, R1 verbalized to R1's sister that he/she was hit in the head during shower and R1's sister observed a "lump" and a "bruise" on R1's head. Therefore, R1's sister took R1 to the hospital for further evaluation.

Based on the hospital medical records, there was no major injuries and Computed Tomography (CT) and exams all came back normal with no loss of consciousness, hematomas, or fractures.

On 6/3/2023, R1's sister filed a police report for the alleged abuse. An officer interviewed R1 and R1 reported that the administrator struck him/her on top of his/her head during shower and this only happened during shower time. However, there was no other details provided such as date and time when these incidents happened.

Based on the police report, officer examined R1's head during the interview and did not observed any visible injuries and bruising on R1's head.

LPA interviewed the caregiver who stated that he/she provided shower to R1 and he/she never hit R1 during shower. In addition, caregiver stated that R1 was capable of showering himself/herself and the caregiver was only holding the shower head. In addition, caregiver stated that administrator did not provide shower to R1.

R1's sister also reported that facility staff hit other residents during care. LPA interviewed GGRC social worker and 2 family members and all of them stated that they did not have any concerns related to the care that is provided to their clients and/or loved ones.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 14-AS-20230601141558
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: SAN FRANCISCO INTERNATIONAL FACILITY (A)
FACILITY NUMBER: 385610003
VISIT DATE: 09/20/2023
NARRATIVE
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Based on interviews, observation and record review, this allegation is deemed to be unsubstantiated. R1 reported of being hit in the head but there is not a preponderance of evidence to prove that it was done by facility staff.

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.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6