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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601076
Report Date: 05/05/2023
Date Signed: 05/05/2023 12:36:00 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
04/27/2023 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230427162904
FACILITY NAME:CRISTINA'S CARE HOMEFACILITY NUMBER:
415601076
ADMINISTRATOR:MADRIGAL, OSCARFACILITY TYPE:
740
ADDRESS:1450 GREENWOOD WAYTELEPHONE:
(650) 952-6641
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:6CENSUS: 6DATE:
05/05/2023
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Caregiver, Wilmina CoronelTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not ensure resident's room is free of clutter
Facility is without toiletries
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 5, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Caregiver, Wilmina Coronel and explained the purpose of the visit. LPA also spoke to Administrator, Oscar Madrigal via telephone and explained the purpose of the visit.

Regarding the allegation that facility staff did not ensure resident’s room is free of clutter, according to the reporting party, a resident’s room was observed to be cluttered and insects were in the room. During the investigation, LPA toured the facility and observed all 6 of the residents rooms. Based on observations, LPA observed all 6 resident rooms to be clean, odor-free and free from clutter.

Regarding the allegation facility is without toiletries, according to the reporting party the facilty bathroom does not have soap and paper towels for visitors to use. During the investigation, LPA toured the facility and observed 2 of the facility's communal bathrooms. LPA observed paper-towels and liquid soap present in both bathrooms.

Therefore, based on the observations conducted during the visit, the above allegations are UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.

Report is reviewed with Caregiver, Wilmina Coronel and a copy is provided with appeals rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
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
04/27/2023 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230427162904

FACILITY NAME:CRISTINA'S CARE HOMEFACILITY NUMBER:
415601076
ADMINISTRATOR:MADRIGAL, OSCARFACILITY TYPE:
740
ADDRESS:1450 GREENWOOD WAYTELEPHONE:
(650) 952-6641
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:6CENSUS: 6DATE:
05/05/2023
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Caregiver, Wilmina CoronelTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff forced resident to take medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 5, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Caregiver, Wilmina Coronel and explained the purpose of the visit. LPA also spoke to Administrator, Oscar Madrigal via telephone and explained the purpose of the visit.

Regarding the allegation that staff forced resident to take medication, there is no additional information forthcoming. However, during the initial reporting, the reporting party indicated that there was a caregiver (name and position not identified) forcing a resident to take his/her medication.

During the investigation, LPA interviewed the administrator and the staff members present. According to the administrator, he denied this allegation and indicated that he has not observed staff forcing residents to take their medication nor has he had any reports of staff forcing residents to take their medication. Based on 2/2 staff interviewed, both denied the allegation and indicated that they don't force residents to take their medication. In addition, interviewed staff indicated that if residents refuse their medications, the staff note it on the resident's medication log, notify the administrator and all required parties. Furthermore, LPA reviewed the medication log and observed facility to document if a resident refuses or takes their medication.

Based on the above interviews conducted and medication log reviewed, this allegation is UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis.

Report is reviewed with Caregiver, Wilmina Coronel and a copy is provided with appeals rights.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2