Complaint Investigation Report, 05/14/2024 — Peninsula Reflections, Colma CA

415600976-5-14-2024-14-AS-ACON-D5SRGW-20240531130123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BRUNO RO , 851 TRAEGER AVE., SUITE 360

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

05/10/2024 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 14-AS-20240510114244

- Facility staff are attempting to illegally evict resident

On 05/14/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver findings regarding the allegations received. LPA met with the administrator Anna Allas and explained the purpose of today's visit.

During the investigation LPA conducted interviews and reviewed pertinent documents regarding the resident's admission agreement and status at the facility. According to documentation reviewed show that the resident was not formally evicted by the facility until 05/13/2024 with an formal eviction notice. The resident is under respite services under contract with him/her hospital. The contract reviewed states that the contract is set to expire on 05/13/2024 and also advised on the initiation of sending him/her to the hospital to continue services due to the expiration of the contract. The facility did not initiate the eviction. Additionally it was found that the hospital the resident is under respite contract with discontinued the refills so the resident can utilize the insurance plan with San Francisco. The facility only initiated emergency services in order for the resident to receive the medication via hospital emergency room out of precaution due to the resident refusing to pay for the medication himself/herself. It was not to evict per interviews. This allegation is unfounded.

This agency has investigated the complaint alleging: Facility staff are attempting to illegally evict resident. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Report is reviewed with administrator. Copy is provided.