415601009-3-22-2023-14-AS-KHOS-CQCS6D-20230328133545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601009
Report Date: 03/22/2023
Date Signed: 03/22/2023 11:51:37 AM

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
12/08/2022 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20221208135034

FACILITY NAME:	PRN CARE HOME LLC		FACILITY NUMBER:	415601009
ADMINISTRATOR:	HU, CHUNJIE		FACILITY TYPE:	740
ADDRESS:	87 BERTA CIR		TELEPHONE:	(650) 754-0234
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	7	CENSUS: 4	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Caregiver, Jack Liang		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff is not properly using residents' P & I money.

INVESTIGATION FINDINGS:

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On 3/22/2023, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings to complaint # 14-AS-20221208135034. LPA Han met with the caregiver, Jack Liang and explained the purpose of the visit. Caregiver called the administrator, Simon Liu informing of LPA's visit.

Regarding to allegation of facility staff is not properly using residents' P & I money, the administrator, Simon Liu denied the allegation and stated that the facility does not handle resident's personal funds.

According to the administrator, resident #1 (R1) gets 2 SSI checks every month; one for the monthly payment at the facility and the other one for resident's personal needs. When the checks arrived, the facility called R1's responsible party to come and pick up the SSI check for R1's personal needs.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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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Control Number 14-AS-20221208135034

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: PRN CARE HOME LLC	FACILITY NUMBER: 415601009
	VISIT DATE: 03/22/2023

NARRATIVE

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Regarding to resident #2 (R2) who was only getting one SSI check for the monthly payment at the facility, however, last month R2 received an additional SSI personal needs check and the facility contacted R2's responsible party who came and picked it up.

According to facility staff #1 (S1) who has been working at the facility since 2017, when resident's SSI personal needs checks arrived, the facility would contact the responsible party to come and pick it up.

LPA interviewed R2's responsible party who validated that the SSI check was picked up.

LPA attempted to call R1's responsible party multiple times but no one answered and the voicemail was not set up and staff stated that R1's responsible party never picked up the phone. He/she would come to the facility every month or every other month to pick up the SSI personal check(s).

Based on the documents provided by the facility, LPA observed R1 and R2's SSI personal needs checks were signed and picked up by the responsible parties in March 2023.

After the investigation, the Department has found that this allegation to be UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis.

This report is reviewed and discussed with the administrator over phone.

A copy is provided.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

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