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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601101
Report Date: 12/02/2022
Date Signed: 12/02/2022 12:29:06 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
06/18/2021 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20210618102222
FACILITY NAME:AEGIS LIVING SAN FRANCISCOFACILITY NUMBER:
415601101
ADMINISTRATOR:CHRISTINE LYONSFACILITY TYPE:
740
ADDRESS:2280 GELLERT BLVDTELEPHONE:
(650) 242-4154
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:100CENSUS: 65DATE:
12/02/2022
UNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Administrator, Cecilia DauthTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Resident being chemically restrained
Facility not following doctors medication orders
Facility has a locked Memory Care Unit
Facility has unqualified staff
INVESTIGATION FINDINGS:
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On December 2, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Administrator/ General Manager, Cecilia Dauth and explained the purpose of the visit.

Regarding the allegation that resident is being chemically restrained and facility is not following doctor's medication orders, according to the reporting party, Resident #1 (R1) was given 75mg of Trazodone instead of between 25-50mg as indicated on the doctor's order and was chemically restrained by the facility.

During the investigation, LPA reviewed R1's file and medical records. Based on the file reviewed, LPA observed that R1's medication list dated 5/29/21 notes R1 is required to take between 25-50mg of Trazodone daily at bedtime, however on 6/3/21, R1 had a medication adjustment which notes R1's Trazodone dosage increased to 75mg daily at bedtime. Furthermore, based on a faxed document reviewed dated 6/5/21, from the facility to R1's physician regarding clarification on R1's Trazodone order, it was indicated by R1's physician that R1 is required to take 75mg of Trazodone daily at bedtime.

Regarding the allegation that facility has a locked memory care unit, according to the reporting party, he/she believed that R1 was inappropriately placed at the facility's memory care unit.

CONT. to 9099C
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: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
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
Control Number 14-AS-20210618102222
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: AEGIS LIVING SAN FRANCISCO
FACILITY NUMBER: 415601101
VISIT DATE: 12/02/2022
NARRATIVE
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During the investigation, LPA reviewed R1's file and interviewed staff. Based on R1's file reviewed, R1 has a diagnosis of dementia. In addition, based on R1's needs and services, R1 was an elopement risk. According to the Health Services Director, Haley Ragasa , R1 moved into the facility in 2020 and had an assigned private caregiver due to his/her wandering behavior. In addition, it was indicated that due to R1's fast progressing dementia, and the expenses incurred of having private caregivers, R1's responsible party requested for R1 to be moved to the Memory Care unit.

Regarding the allegation that facility has unqualified staff, according to the reporting party, the facility was providing R1 with the wrong medication dosage.

During the investigation, LPA reviewed six random staff files and observed staff training records. LPA observed CPR and First Aid Certificate to be current. In addition, LPA reviewed three random medical technician's (med-tech) files and observed a copy of their Medication Training and RELIAS on boarding training. According to the Administrator, the facility conducts monthly in-service training with all staff. In addition, the Administrator indicated that the Health Services Director, Haley Ragasa conducts trainings with the care team to maintain compliance with state requirements.

Therefore, based on the information collected, and interviews conducted, 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 Administrator, Cecilia Dauth and a copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC9099 (FAS) - (06/04)
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