Complaint Investigation Report

415601101-1-12-2024-14-AS-KHOS-CZQJTV-20240122062034

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

04/03/2023 and conducted by Evaluator Audrey Jeung

COMPLAINT CONTROL NUMBER: 14-AS-20230403164840

- Facility placed a resident in another residents room without notifying responsible party.

Based on observations and review of records, these allegations are substantiated. The preponderance of evidence standard has been met.

During initial complaint visit on 4/11/23, LPAs Jeung and Donato visited all 17 memory care apartments, and detected the smell of urine in 3 rooms, despite the overwhelming floral scent of a cleaner/disinfectant product and that LPAs were wearing surgical masks.

As confirmed by staff and indicated in facility's billing records, client #2 was relocated to room 101 with client #1 on 3/14/23. There was no notice given to conservator of client #1 about this new living arrangement.

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