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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600105
Report Date: 02/22/2024
Date Signed: 02/22/2024 01:38:23 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
02/20/2024 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20240220103803
FACILITY NAME:CHATEAU SABELLEFACILITY NUMBER:
415600105
ADMINISTRATOR:MORALES, GABRIELAFACILITY TYPE:
740
ADDRESS:2921 ISABELLE STREETTELEPHONE:
(650) 341-2296
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:6CENSUS: 6DATE:
02/22/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nancy CastleTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff are mismanaging resident's medications
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Jeung reviewed client files and reviewed Centrally Stored Medications Records for 2 clients.
It is alleged that client was given a medication that had been dropped on the floor. This alleged incident is not a violation of California Code of Regulations, Title 22, RCFE regulations.

Therefore, this complaint is determined to be unfounded.

See Facility Evaluation Report for deficiencies cited based on medication records review.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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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