415601039-12-8-2022-14-AS-KHOS-CQCPT9-20230328113530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601039
Report Date: 12/08/2022
Date Signed: 12/08/2022 05:06:08 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
11/29/2022 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20221129102154

FACILITY NAME:	CADENCE MILLBRAE		FACILITY NUMBER:	415601039
ADMINISTRATOR:	STROMGREN, KIEL		FACILITY TYPE:	740
ADDRESS:	1201 BROADWAY		TELEPHONE:	(650) 742-9150
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY:	165	CENSUS: 127	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Margaret Madrid		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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- Facility is operating without an Administrator

- Transportation vehicles are in disrepair

INVESTIGATION FINDINGS:

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LPA Jeung met with business office manager and discussed the above allegations. Copies of vehicle maintenance records for Ford Starcraft bus and qualifications of interim administrator/vice-president of operations are provided and reviewed.
9/21/22 was administrator/executive director's last working day. Since that time, vice president of operations has been acting in this position. LPA was made aware of this transition during a case management visit on 9/22/22 for an unrelated incident. Personnel Report (LIC500) and RCFE administrator certificate for Kelly Metz was submitted to CCLD as requested. According to LIC500, Ms. Metz maintains a regular and reasonable schedule at facility.
According to Ms. Madrid, the Ford Starcraft bus is the only facility vehicle, and it has not been driven for over 3 months because the Class B driver resigned on 8/18/22 and no one has filled this position. Prior to transporting residents and upon hiring a Class B driver, the bus will be inspected for maintenance and safety and cleared for service. Despite expired registration stickers on license plate, vehicle registration was paid on 6/1/22 and proof of payment is provided to LPA.
Based on this investigation, this complaint is determined to be unfounded, meaning that the allegations could not have happened and/or are without a reasonable basis.

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: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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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