415600821-7-1-2022-14-AS-KHOS-CKHL7T-20221024083053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600821
Report Date: 07/01/2022
Date Signed: 07/01/2022 04:02:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/03/2022 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220103130159

FACILITY NAME:	HOME SWEET HOME SENIOR CARE		FACILITY NUMBER:	415600821
ADMINISTRATOR:	NEDILJKA MATIJAS		FACILITY TYPE:	740
ADDRESS:	1560 BRYANT STREET		TELEPHONE:	(650) 992-2727
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	55	CENSUS: 32	DATE:	07/01/2022
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Iren Ludney		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff opens resident’s mail without his consent

INVESTIGATION FINDINGS:

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***THIS AN AMENDED REPORT CHANGING THE REPORT TO PUBLIC. REPORT DETAILS REMAIN THE SAME***

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver the findings regarding the allegation received. LPA met with administrator Iren Ludney and explaine purpose of today's visit.

During the course of the investigation LPA conducted interviews with staff and outside agencies regarding the matter. The complainant wished to not be reached. It was discovered that the opening of the mail was an accident per the statement provided by the administrator. She had opened the letter on accident as it was addressed to "recptionist". She assumed it was addressed to the facility's receptionist and opened the mail item. She then discovered that it was not addressed to the facility but rather to SamTrans/Redi-wheels. She then brought it to the attention of the resident who was sending out the mail. LPA confirmed with local long term ombudsman as well regarding the matter as being a one time accident and was not done intentionally. Although it did happen, it was an error and this was the only known occurrence of this happening. This allegation is unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

Report is reviewed with the administrator. No citations issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

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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