415601015-5-14-2025-14-AS-KHOS-DH2MZ5-20250526100234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601015
Report Date: 05/14/2025
Date Signed: 05/14/2025 12:33:12 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
04/02/2025 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20250402145926

FACILITY NAME:	TROUSDALE, THE		FACILITY NUMBER:	415601015
ADMINISTRATOR:	CHU, SYLVIA		FACILITY TYPE:	740
ADDRESS:	1600 TROUSDALE DR		TELEPHONE:	(650) 443-3700
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	140	CENSUS: 112	DATE:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Memory Care Director, Anne Aquino		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff mismanaging resident’s medication.
Staff did not ensure resident’s medications were refilled in a timely manner.

INVESTIGATION FINDINGS:

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On May 14, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings of a complaint investigation. LPA met with Memory Care Director and explained the purpose of today’s visit.

Regarding to the allegation of- Staff mismanaging resident’s medication, the reporting party stated that resident #1 (R1)’s responsible party witnessed staff #1 (S1) who was in training gave all of R1’s medication to R1 at once in R1’s hand resulted R1 struggled not to drop the medications and almost lost a medication in R1’s recliner.

According to the responsible party, S1 placed all R1’s medications on R1’s palm so when R1 tried to take it one by one, R1 almost dropped it, however, R1 was able to manage not to drop any and S1 stayed with until R1 took all of the medications.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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-20250402145926

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: TROUSDALE, THE	FACILITY NUMBER: 415601015
	VISIT DATE: 05/14/2025

NARRATIVE

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As part of the investigation, LPA interviewed staff #2 (S2) who was training S1 on the day of the incident and stated that S1 was in training, and both stayed to ensure that R1 took all the medications then they left the room.

After the investigation, this allegation is unsubstantiated because there was no mistake made with R1’s medication administration. It was an accident that R1 almost dropped a pill while taking his/her pills but both staff members followed R1’s evaluation and plan and stayed with R1 to ensure R1 took all the medications before exiting the room as this was observed by the responsible party.

Regarding to the allegation of staff did not ensure resident’s medications were refilled in a timely manner, the reporting party stated that on March 30, 2025, the responsible party received a call from the facility reporting that two of R1's medications were running low but the facility had enough to last for a few more days.

On the next day (March 31, 2025), the responsible party received a from R1 at 7:01pm and stated that he/she did not take one of the medications that was running low. Subsequently, the responsible party called the facility and verified the medication ran out and delivered the medication that night. The responsible party also stated that the facility was supposed provide notification when R1’s medication has less than two weeks supply.

According to the Memory Care Director, the facility has two types of medication refill systems for the residents. When the facility is managing the medications, the facility is responsible to ensure all the refills are done and when the resident or their responsible party is managing the medications, they will be the one to keep track of all the refills and the facility will make a courtesy call 2 weeks before the medications run out.

The Memory Care Director stated that R1’s medication is managed by R1’s responsible party and S2 conducted the courtesy call 2 weeks prior to the medications were running low.

LPA interviewed S2 who stated that he/she conducted a courtesy call 2 weeks in advance to the responsible party informing them that R1's medication was running low.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 14-AS-20250402145926

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: TROUSDALE, THE	FACILITY NUMBER: 415601015
	VISIT DATE: 05/14/2025

NARRATIVE

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Based on the documents provided by the facility, under Resident Evaluation, it indicated that R1 does not receive medication administration assistance from the facility instead, resident or family manages all aspects of the refills, including ordering and delivery of medications.

Based on 24 hours shift report, it was documented by staff that on 3/30/2025, a courtesy call was made to R1’s family for the refills.

After the investigation, this allegation is deemed to be unsubstantiated because R1’s family is managing R1’s medication and courtesy calls were made for the refills.

Although the above allegation 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 memory care director. A copy is provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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