415600223-11-15-2023-14-AS-KHOS-CY8KSK-20231205070940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600223
Report Date: 11/15/2023
Date Signed: 11/15/2023 12:39:33 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
02/09/2022 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220209160848

FACILITY NAME:	STERLING COURT		FACILITY NUMBER:	415600223
ADMINISTRATOR:	CHARLES, SARAH ST.		FACILITY TYPE:	740
ADDRESS:	850 NO. EL CAMINO REAL		TELEPHONE:	(650) 344-8200
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	24	CENSUS: 23	DATE:	11/15/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Novie Villafuerte		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Staff did not seek timely medical attention
- Facility does not adhere to residents' Admissions Agreements
- Staff did not observe residents for changes in condition
- Staff did not respond to residents' calls for assistance in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPA Jeung interviewed assisted living director and obtained copies of relevant client records.

Based on reviews of facility records--including signed admission agreement--and documents provided by complainant--including 100+ pages of text messages from/to facility staff--medical records, and interviews with staff, these allegations are determined to be unsubstantiated.

On 10/24/21, staff noticed that client #1 had a change of condition and attempted to contact PoA immediately and 9-1-1, despite client's request NOT to call 9-1-1. Possibly due to extreme weather, 9-1-1 did not respond to call. PoA responded 30 minutes later after convincing client to agree to staff calling 9-1-1. Staff called 9-1-1 again; the line was busy and not answered. Another 9-1-1 call was made; caller was placed on hold. Staff pressed the Mobile Help Life Line and requested help while waiting for 9-1-1 to respond to call. EMTs arrived 25 minutes later. This incident was reported to CCLD as required.

- Continued on next page -

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Audrey Jeung	TELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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 2

Control Number 14-AS-20220209160848

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: STERLING COURT	FACILITY NUMBER: 415600223
	VISIT DATE: 11/15/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

It is alleged that client was charged for transportation to medical appointments and that this service is included in the admission agreement. According to the Admission agreement signed by PoA for client #1, non-emergency transportation will be planned and/or arranged to medical appointments, and "facility will assist in arranging for a transportation provider...and the resident is responsible for the fare, if any."

Client #1 developed deep tissue injury of heels due to pressure, which was documented in resident notes in April 2021 and treated by home health RNs. Client was already receiving home health visits since March 2021 for physical and occupational therapy. Wound care for heel wounds was documented by home health visit reports starting in May 2021. Request for healing wound exception was submitted to CCLD on 6/23/21 with physician's report. Care plans, assessment from vascular surgeon and home health RN visit notes dated in June 2021 and August 2021 were reviewed.

Client #1 was admitted 11/19/20 and discharged 1/31/22, but was out of the facility for almost 4 1/2 months hospitalized, in rehabilitation, or other. According to text messages to assisted living director, staff failed to respond to client's emergency calls in timely manner on several occasions. History report of calls and responses was not available until LPA requested administrator to contact Tek Tone to make this information accessible to staff on 2/18/22. Based on call history report for client #1 for August, September, October 2021, client called for staff up to 6 times per day; in August, staff responded after 16 minutes; in September, there was a 25 minute response and a 21 minute response; in October, there was a 16 minute response. Staff responded to all other calls in a timely manner--most within 5 minutes. These lengthy response times were rare occurrences and not indicative of failing to respond to calls timely.

Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Audrey Jeung	TELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2