415600966-12-21-2023-14-AS-KHOS-CZ4T6K-20240102132716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600966
Report Date: 12/21/2023
Date Signed: 12/21/2023 04:00:26 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
11/14/2023 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20231114102411

FACILITY NAME:	GEORGE ANNE HOME		FACILITY NUMBER:	415600966
ADMINISTRATOR:	JOHNSON, MARIA LU		FACILITY TYPE:	740
ADDRESS:	849 N DELAWARE STREET		TELEPHONE:	(650) 931-4741
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	6	CENSUS: 6	DATE:	12/21/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Maria Johnson		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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- Staff are denying POA visits to the facility

- Residents must go to bed early

INVESTIGATION FINDINGS:

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LPA Jeung met with staff and interviewed client and visiting family member.

Based on investigation by the Community Care Licensing Division of the CA Department of Social Services--which included records review and interviews with staff, clients, and others--these allegations are determined to be unfounded, meaning that the allegations could not have happened and/or are without a reasonable basis.

Prior to 9/14/23, POA for health care of client #1--referenced on LIC811 of 11/21/23--visited facility 5 days per week. Visits lasted a minimum of 30 minutes, up to 5 hours, and always included lunch and/or dinner service. She did not sign in on facility's visitation log. After 9/14/23, POAHC visits lasted up 30 minutes, only once or twice per week. She has never been forbidden to visit client #1.

There have been no complaints about residents being forced to go to bed earlier than they would like to. Most of the residents tire easily and prefer to go to bed early. If someone does not want to go to sleep, staff will help them to get ready for bed, and s/he is free to go to sleep as s/he desires.

Unfounded

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: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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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