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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601101
Report Date: 11/07/2023
Date Signed: 11/08/2023 08:12:16 AM

Unsubstantiated


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
06/28/2023 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230628150627
FACILITY NAME:AEGIS LIVING SAN FRANCISCOFACILITY NUMBER:
415601101
ADMINISTRATOR:CECILIA DAUTHFACILITY TYPE:
740
ADDRESS:2280 GELLERT BLVDTELEPHONE:
(650) 952-6100
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:100CENSUS: 61DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Cecila Dauth & Hayley RagasaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff does not help facilitate communication between reporting party and resident
Facility staff chemically restrained the resident
INVESTIGATION FINDINGS:
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On 11/07/23, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegations. LPA met with Administrator, Cecilia Dauth & Resident Wellness Director Hayley Ragasa and explained the purpose of today's visit.

Regarding the allegation of facility staff does not help facilitate communication between reporting party (RP) and resident (R1). It was reported that the facility is not helping RP communicate with R1.

During the investigation, LPA interviewed staff members and five out of eight staff mentioned that there are no issues with regards to any family members calling to speak to residents. The only times that a phone call might not go through is when a resident is agitated, sleeping, is on an activity or having meals. In cases or residents with dementia, residents might not be lucid at that time or don’t even remember who they are talking to. The facility is also able to transfer calls so that residents will be able to talk to family members who call. Families are also encouraged to visit, especially for residents who are in hospice.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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
Control Number 14-AS-20230628150627
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: 11/07/2023
NARRATIVE
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Two staff members also mentioned that when R1 gets a call, they give the phone to R1. However, R1 sometimes doesn’t understand or know how to communicate due R1s cognitive disorder.

Based on records review, RP sent timelines where in RP was able to get in contact with R1 by calling the facility. There were also instances where another family member calls RP due to the request of R1. The visitation logs only showed that RP only visited the resident once since being admitted to the facility.

Regarding the allegation facility staff chemically restrained the resident. RP mentioned that R1 is always in mood stabilizers because of R1s agitation and was always tired.

Based on records review, R1 has trouble sleeping and was prescribed Trazodone to help assist. Trazodone was given as a PRN medication and is to be administered after dinner if needed. R1 was prescribed Trazodone starting March of 2023. During this month R1 was given 7 doses on different days. In April 2023, R1 was given 2 doses on different days also. The following months there were no more records of Trazodone being given. A total of just 9 doses from the time it was prescribed were administered.

LPA interviewed two Medical Technicians, and both observed that when R1 is given Trazodone, R1 gets groggy and is then assisted to bed. Both Administrator and Wellness Director stated that the facility is not able to chemically restrain residents. Any medication given to residents are doctor prescribed. Facility only follows doctors’ directions and just report if there are any changes to the resident.

Therefore, based on the interviews conducted, files reviewed, and information collected, the allegations mentioned 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 and a copy is provided.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2