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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415202046
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:28:57 PM

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
09/02/2020 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20200902134018
FACILITY NAME:GORDON HOMEFACILITY NUMBER:
415202046
ADMINISTRATOR:MADONNA VALENCIAFACILITY TYPE:
734
ADDRESS:1415 GORDON ST.TELEPHONE:
(650) 365-3688
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:5CENSUS: 4DATE:
04/04/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Claire AscalonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-- Resident sustained an injury while in care

-- Staff financially abusing residents' P and I money
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Based on review of client records--including cash maintained and P and I transaction logs--and interviews with staff, these allegations are determined to be unsubstantiated.
Two residents experienced minor injuries within the prior 3 weeks of LPA's initial complaint visit on 9/14/2020. LPA reviewed documentation of both injuries, including revised care plans. Cause of injury to client #5 was attributed to an accident and injury to client #2 was attributed to client's self injurious behavior.
According to administrator, Amazon accounts were set up in clients' names for items that she buys for them, but are billed to and paid by one account for the facility. Cash is withdrawn from clients' P and I money accordingly after purchases are paid by facility. On 9/14/2020, P and I money for 5 residents was counted and compared with P & I transaction logs. Except for two minor discrepancies for 2 clients, amounting to a $0.42 overage of cash for client #1 and $41 overage of cash for client #2, residents' cash was exactly the balance amount from their transaction logs. Discrepancies were to be investigated by staff, including verifying the accuracy of math calculations.

Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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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