415601039-6-8-2023-14-AS-KHOS-CT6HG2-20230626061021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601039
Report Date: 06/08/2023
Date Signed: 06/08/2023 05:34:34 PM

Substantiated

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
09/19/2022 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220919214843

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: 131	DATE:	06/08/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Michael Sharkey and Margaret Madrid		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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- Facility did not provide a comfortable temperature for residents in care

- Facility did not adhere to admissions agreement

INVESTIGATION FINDINGS:

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LPA Jeung met with business office manager and new executive director to discuss allegations, which were initially addressed in September 2022, when summer temperatures ranged from 75 degrees F to 97 degrees F for 7 days from 9/3/22. LPA toured facility and noted that the apartments which faced west were subject to the afternoon sun. Residents' apartments are not equipped with air conditioning, although page 2 of facility's Residency Agreement stated that apartments are provided with "...water, heat, electricity, air conditioning..."

Based on LPA's observations during initial visit on 9/22/22 and information obtained from facility staff and complainant, these allegations are substantiated. The preponderance of evidence standard has been met.

Deficiencies of the California Code of Regulations, Title 22 are cited on a following page.

Substantiated

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: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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-20220919214843

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: CADENCE MILLBRAE	FACILITY NUMBER: 415601039
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/22/2023 Section Cited CCR 87303(b)(2)	1 2 3 4 5 6 7	MAINTENANCE AND OPERATION A comfortable temperature for residents shall be maintained at all times. The facility shall cool rooms to a comfortable range, between 78 degrees F and 85 degrees F, or in areas of extreme heat to 30 degrees F less than the outside temperature. This requirement was not met, as extreme	1 2 3 4 5 6 7	Plan of correction to be submitted to CCLD BY DUE DATE
	8 9 10 11 12 13 14	heat existed in September 2022, when temperature was up to 97 degrees, and rooms on the west side of building were not comfortably cool. Licensee failed to ensure that residents' apartments were maintained at comfortable temperature, which posed a potential health, safety or personal rights risk to clients in care.	8 9 10 11 12 13 14
Type B 06/08/2023 Section Cited CCR 87507(f)	1 2 3 4 5 6 7	ADMISSION AGREEMENTS The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met, as licensee failed to ensure that residents' apartments were air conditioned--as stated in residency	1 2 3 4 5 6 7	Residency Agreements were revised, and no longer state that apartments are air conditioned. Copy of updated admission agreement is provided to LPA today. Deficiency corrected and cleared.
	8 9 10 11 12 13 14	agreements--which posed a potential health, safety or personal rights risk to clients in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Audrey Jeung	TELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC9099 (FAS) - (06/04)

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