415601039-5-8-2024-14-AS-ACON-D7GLG9-20240724084422

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601039
Report Date: 05/08/2024
Date Signed: 05/08/2024 07:11:26 PM

Unsubstantiated

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
02/15/2024 and conducted by Evaluator Audrey Jeung

COMPLAINT CONTROL NUMBER: 14-AS-20240215114634

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: 105	DATE:	05/08/2024
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Joan Newman		TIME COMPLETED:	07:00 PM

ALLEGATION(S):

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- Staff are not providing medication as prescribed

INVESTIGATION FINDINGS:

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LPA Jeung reviewed file for client #1 and interviewed client #1. Staff involved in incident of 1/11/24 regarding client #1 is no longer employed. According to client, medication Seroquel (Quetiapine) was not given. Based on facility Progress Notes and Medication Administration Order Tracking, on 1/11/24, the medication was not maintained and not given. Client recounted that medication staff were unable to procure medication, so he requested to be taken to hospital, where he would be given the medication. This is also documented in the Progress Notes. Client said that he received medication and returned to facility without an overnight stay. It is documented that staff ordered medication on 1/9/24, but had not received it.
It cannot be determined that staff failed to administer medication as prescribed, as the electronic MAR and electronic Medication Administration Order Tracking--which reflects medications that were GIVEN--show inconsistent information for administration of Quetiapine in January 2024.

Based on information obtained, including interviews with resident and staff, this allegation is determined to be unsubstantiated. Although the allegation may have occurred or is valid, there is not enough evidence to prove the alleged violation did or did not occur.

Unsubstantiated

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: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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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