415601101-3-19-2024-14-AS-KHOS-D3QGZ6-20240326054638

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601101
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:27:47 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
03/13/2024 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20240313115017

FACILITY NAME:	AEGIS LIVING SAN FRANCISCO		FACILITY NUMBER:	415601101
ADMINISTRATOR:	CECILIA DAUTH		FACILITY TYPE:	740
ADDRESS:	2280 GELLERT BLVD		TELEPHONE:	(650) 952-6100
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	100	CENSUS: 87	DATE:	03/19/2024
		UNANNOUNCED	TIME BEGAN:	01:18 PM
MET WITH:	Cecilia Dauth		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff are not following proper infection control requirements

INVESTIGATION FINDINGS:

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On 3/2024, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Administrator Cecilia Dauth and explained the purpose of today's visit.

Regarding the allegation of staff are not following proper infection control requirements, the Reporting Party (RP) stated that there is no PPE for the staff. RP stated that they don’t have any face shields or hair covers. RP stated that all the residents are being isolated except one.

LPA interviewed staff members and 6 out of 6 mentioned that there were emergency PPEs provided by the facility. LPA also interviewed Administrator Cecilia Dauth & Wellness Director Hayley Ragasa, both stated that part of their protocol is to have garbage bin and supply outside the rooms of infected residents. This is for when staff enters, they wear the PPE supply and when exiting, throw the PPEs right away on the bin. Face shields are also available when requested by staff. Residents who were infected are isolated in another wing of the facility. One staff member, S1, also mentioned that the residents were provided food in their rooms.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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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Control Number 14-AS-20240313115017

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: AEGIS LIVING SAN FRANCISCO	FACILITY NUMBER: 415601101
	VISIT DATE: 03/19/2024

NARRATIVE

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LPA also toured the storage area where these PPE supplies are stored. LPA has observed enough emergency supply needed for the facility. LPA observed boxes and cabinet full of gloves, boxes of wipes, storage of supplies that are placed outside rooms of residents, boxes of isolation gowns and masks.

Based on records review, the infection protocol of the facility states that all staff and volunteers providing direct care to a resident who has a communicable disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents or chemicals through the respiratory system, skin, or mucous membranes of the eyes, nose, or mouth. PPE may include gloves, gowns, masks, respirators, and eye protection. Face shield and hair covers are not a requirement. Receipts are also provided by the facility as proof of additional purchase of PPEs.

Therefore, based on the interviews conducted, files reviewed, and information collected, the allegation mentioned is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Report is reviewed and copy is provided.

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC9099 (FAS) - (06/04)

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