Complaint Investigation Report

415600976-1-31-2023-14-AS-KHOS-CQCLDW-20230328084037

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SF COASTAL AC/SC , 851 TRAEGER AVE., SUITE 360

This is an official report of an unannounced visit/investigation of a complaint received in our office on

10/21/2022 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 14-AS-20221021124700

- Facility does not inform resident's responsible party of changes in resident's condition

- Facility staff mismanaged resident's medications

On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an un-announced complaint investigaton visit to deliver the findings for the allegations listed above. LPA spoke to Wellness Director Kathy Nguyen and explained the purpose of today's visit.

During the course of the investigation LPA conducted interviews, reviewed records of R1, and made observations of the resident. It cannot be determined the source of the lice. No other residents or staff had lice before or after R1. There were not many visitors to R1. LPA could not determine the source. In regards to informing the responsible party of changes in resident's condition, and medications mismanagement, LPA could not determine if either are true. Facility says updates and informing of the the responsibily pary did happen at all times. In regards to medications, there was a flow of information issue between doctor and responsible party with the facility that disrupted or caused issues with medication information being shared with the facility. These allegations are unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. No citations issued. Report is reviewed with Kathy Nguyen.