415601039-3-16-2021-14-AS-KHOS-BZ7MEQ-20210317093308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601039
Report Date: 03/16/2021
Date Signed: 03/16/2021 04:00:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/06/2020 and conducted by Evaluator Bertha Raygoza

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20200706105908

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:	188	CENSUS: 105	DATE:	03/16/2021
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Kiel Stromgren, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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- Facility staff failed to give resident medication on a timely basis
- Resident was not allowed visitors
- Resident was not allowed to make phone calls

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Raygoza made a subsequent complaint virtual visit on the above allegations. LPA stated purpose of visit to Staff in Charge, Margaret Madrid.

- Facility staff failed to give resident medication on a timely basis. During course of investigation, Medical record log indicating time and date of administering medication for R1 reflects timely administration of medication by Staff. Therefore, the allegation was deemed Unsubstantiated.
- Resident was not allowed visitors. Based on COVID Pandemic the facility adheres to visitor restriction policy, social distancing, masks and safety requirements for compromised health conditions as for R1. Therefore, the allegation was deemed Unsubstantiated.
- Resident was not allowed to make phone calls. Based on R1 in possession of a cell phone and staff assistance available for making calls or charging phone there is cell phone access. Based on free telephone downstairs in lobby for all resident's use, there is phone availability. Therefore, the allegation was deemed Unsubstantiated.

Although the allegations 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 allegations are unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Bertha Raygoza	TELEPHONE: (650) 266-8833
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

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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