415601165-7-23-2024-14-AS-AMEN-D8DME6-20240822093213

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601165
Report Date: 07/23/2024
Date Signed: 07/23/2024 04:12:46 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
07/22/2024 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20240722165059

FACILITY NAME:	GENERATIONS CARE HOME		FACILITY NUMBER:	415601165
ADMINISTRATOR:	MEHTA, IRENE		FACILITY TYPE:	740
ADDRESS:	859 CAMARITAS CIR		TELEPHONE:	(650) 438-6710
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	6	CENSUS: 5	DATE:	07/23/2024
		UNANNOUNCED	TIME BEGAN:	12:43 PM
MET WITH:	Irene Mehta		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility retained a resident with prohibited health condition who is not under hospice.

INVESTIGATION FINDINGS:

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On 7/23/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Administrator Irene Mehta and explained the purpose of the visit.

Regarding the allegation of facility retained a resident with prohibited health condition who is not under hospice. Reporting party (RP) stated that resident (R1) had stage 4 pressure injury when sent to the hospital. Resident was not in hospice.

Based on records review, there is only one resident in the facility who has pressure injury. R1 was last checked on January 2024 and had a diagnosis of a small pressure sore. Nursing care was recommended. Home Health visited and trained staff to care for the wound. Wound was being maintained with care based on the progress notes provided.

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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-20240722165059

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: GENERATIONS CARE HOME	FACILITY NUMBER: 415601165
	VISIT DATE: 07/23/2024

NARRATIVE

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LPA interviewed the Administrator (ADM) and it was mentioned that the staff was trained to care for the wound. Wound was healing and then comes back again despite facility staff caring for it and constant repositioning of R1. When R1 was sent to the hospital for abdominal pain last May 6, 2024, the wound was at stage 2. When R1 was released from the hospital, R1 went on hospice.

LPA was also able to interview the resident (R1) and the resident stated that he/she is happy in the facility and that the staff takes good care of him/her and wants to stay here in the facility.

Based on interviews and records review, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED.

Report is reviewed and copy is provided.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC9099 (FAS) - (06/04)

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