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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600979
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:59:08 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
04/23/2024 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20240423090502
FACILITY NAME:GRATIA HOMEFACILITY NUMBER:
415600979
ADMINISTRATOR:LETRONDO, LILIBETHFACILITY TYPE:
735
ADDRESS:2585 WENTWORTH DRIVETELEPHONE:
(650) 580-1266
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:4CENSUS: 3DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Manager, Veronica CochonTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Facility is in financial distress.
Staff are mishandling resident's P&I funds.
Food services are inadequate.
Staff do not ensure that residents' personal information is kept confidential.
INVESTIGATION FINDINGS:
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On July 23, 2024, Licensing Program Analyst (LPA), Murial Han conducted an announced visit to deliver the complaint investigation findings. LPA met with manager, Veronica Cochon and explained the purpose of the visit.

Regarding to facility is in financial distress, the reporting party stated that the administrator sent group text messages to employees to save electricity and heater.

As part of the investigation, LPA interviewed the administrator who denied the allegation and LPA interviewed facility staff and all of them denied of receiving any type of communication from the administrator regarding to save electricity, heater, water, etc.

During LPA's visit on 4/30/2024, LPA observed the facility to be cleaned and the temperature was comfortable.

After the investigation, this allegation is deemed to be unsubstantiated.

Regarding to the allegation of- staff are mishandling resident's P & I funds, there is no additional information forthcoming from the reporting party. However, the information that was provided by the reporting party during the initial reporting was similar to a complaint that was investigated by CCL in March 2024 in reference to complaint number 14-AS-20240329092656. In addition, there was no change in resident census since March 2024, therefore, please refer to CCL report LIC 9099 for the investigation outcome regarding to this allegation.

After the investigation, this allegation is deemed to be unsubstantiated.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
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 4
Control Number 14-AS-20240423090502
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GRATIA HOME
FACILITY NUMBER: 415600979
VISIT DATE: 07/23/2024
NARRATIVE
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Regarding to the allegation of- food services are inadequate, the reporting party reported that the facility has a daily menu, but the ingredients are not even available and there is a lot of missing food from the menu.

As part of the investigation, LPA interviewed the house manager who stated that the facility does grocery shopping on a weekly basis and as needed and the shopping list is prepared from the daily menu. The house manager acknowledged that there were times some of the ingredients would run out by the mid or the end of the week and when that happened, they would either go to the nearby grocery store and buy items or they would replace the item with the same food group.

LPA interviewed facility staff who were the designated cooks and they validated the information that was provided by the house manager.

During LPA's visit on 4/30/2024, LPA observed some items/ingredients were missing from the daily menu but the facility staff was able to show the replacement items that would be used.

After the investigation, this allegation is deemed to be unsubstantiated.

Regarding to the allegation of - staff do not ensure that residents' personal information is kept confidential, the reporting party stated that the facility used personal information as a scratch paper and there were resident's personal information in the drawer.

As part of the investigation, LPA interviewed the administrator and the house manager and both of them denied the allegation.

During LPA's visit on 4/30/2024, LPA toured the facility, and during the tour, LPA opened drawers in the common area, and did not observe any residents' personal information. LPA observed all residents' information were locked in the cabinet in the living room.

After the investigation, this allegation is deemed to be unsubstantiated.

Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

This report is reviewed and discussed with the house manager and the administrator who was on the phone. A copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4