Complaint Investigation Report

415601009-3-2-2023-14-AS-KHOS-CX4LZQ-20231030091220

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

02/22/2023 and conducted by Evaluator Audrey Jeung

COMPLAINT CONTROL NUMBER: 14-AS-20230222144033

Hong Yi Liang (Jack) and Sheng Xi Liu (Simon)

- Staff does not adequately maintin resident's medication records

- Staff does not provide adequate food service

LPA Jeung met with staff, observed clients--one at dining table and 2 in their bedrooms--inspected food supply, and reviewed client files, including medications. LPA observed clients' medications--2 clients get medications from 1 pharmacy.

Based on information observed during this visit, these allegations are substantiated. The preponderance of evidence standard has been met.

Facility does not maintain Centrally Stored Medication Records, which are required. LPA observed that Medication Administration Records are maintained, which are not required.

Two day supply of fresh vegetables is not maintained. Half a head of napa cabbage is observed in refrigerator as well as 2-day supply of fresh protein and fruit, 7 day supplies of canned fruit, vegetables and protein.

Deficiencies of the California Code of REgulations, Title 22, are cited on a following page.