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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600689
Report Date: 08/05/2024
Date Signed: 08/05/2024 06:39:50 PM

Unsubstantiated


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
03/07/2024 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20240307142544
FACILITY NAME:STRATFORD, THEFACILITY NUMBER:
415600689
ADMINISTRATOR:CAMILLE CHRISTIEFACILITY TYPE:
741
ADDRESS:601 LAUREL AVETELEPHONE:
(650) 342-4106
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:96CENSUS: 78DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Lori Wolfe and Janie WooTIME COMPLETED:
07:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff not following resident physicians report
- Facility Administrator is not certified
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Based on client and facility records reviewed, information obtained from facility staff--including administrator-- and CDSS Administrator Certification Unit, these allegations are determined to be unsubstantiated. Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur.

Four residents' physicians determined that they were unable to store and administer their medications, so facility provided this assisted living service until authorizations were obtained from MDs for their respective spouses to store and administer medications. However, facility failed to implement assisted living services in accordance with facility guidelines. See Facility Evaluation Report for deficiency.

Executive director Janie Woo was appointed as facility administrator in November 2023. She applied for RCFE administrator certification approximately 6 months ago, but has not yet received administrator certificate. According to CDSS Administrator Certification Unit, status is pending. This could either mean that her application is pending review of information submitted or that information has been reviewed, approved, and that certificate is not yet processed/issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
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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