<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600399
Report Date: 04/29/2021
Date Signed: 04/30/2021 12:28:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/10/2021 and conducted by Evaluator Mohamed Filouane
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20210310114055
FACILITY NAME:SAN FRANCISCO RCFEFACILITY NUMBER:
385600399
ADMINISTRATOR:ADELA MORALESFACILITY TYPE:
740
ADDRESS:887 POTRERO AVENUETELEPHONE:
(628) 206-6436
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:59CENSUS: 38DATE:
04/29/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Adela MoralesTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately touched a resident while in care
Staff mishandle residents medications while in care
Staff behavior poses as a risk to residents
Staff mishandle residents food
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/29/21, Licensing Program Analyst (LPA) Mohamed Filouane conducted a follow-up visit regarding this complaint investigation. Because of COVID-19 and social distancing measures, LPA Filouane called and spoke to Administrator Adela Morales over the phone and delivered the findings.

Concerning the allegation of facility staff inappropriately touching a resident while in care, LPA Filouane investigated this allegation, interviewed the facility Administrator, staff members, residents, and reviewed the facility's internal investigation documents. LPA's interview with the Administrator revealed the facility's internal investigation concluded as unsubstantiated to the claim of a staff member inappropriately touching a resident. The Administrator denied this allegation and stated the facility's investigation found no evidence to indicate a staff member inappropriately touched a resident. LPA's interviews with facility staff members revealed no witnesses were present during the alleged unsolicited touching of a resident from the staff member in question. Staff members stated in interviews that they had never seen the staff member in question inappropriately touch a resident. One staff member stated in an interview that the act of inappropriately touching a resident seemed out of character for the staff member in question.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Mohamed Filouane
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 14-AS-20210310114055
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAN FRANCISCO RCFE
FACILITY NUMBER: 385600399
VISIT DATE: 04/29/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During a resident interview, one resident stated they had never seen the staff member in question inappropriately touch the resident. This resident also confirmed that the staff member in question is good and does their job in taking care of residents. In a second interview with resident two (R2), R2 verified that the staff member in question had, at one time in the dining room of the facility, leaned close and placed their hand on the shoulder of the resident in question. In the interview, R2 stated the staff member in question did not seem to have intentions to harm the resident but was too friendly with the resident in question. After review, this allegation is unsubstantiated.

Concerning the allegation of facility staff mishandling the medication of residents while in care, LPA Filouane interviewed the Administrator, staff members, residents, and reviewed medication records of residents. The Administrator denied this allegation and stated they had never received reports of a resident's medication being mishandled. Staff members stated in interviews they had not encountered or observed medication mishandling in the facility. In resident interviews, LPA asked if staff mishandled medication, and residents stated staff would rush during medication aid. After review, this allegation is unsubstantiated.

Concerning the allegation of facility staff's behavior posing a risk to residents, LPA interviewed the Administrator, staff members, and residents. During the interview with the Administrator, the Administrator denied this allegation. LPA asked if there was a report of staff members giving each other piggyback rides. The Administrator stated when one staff member had hurt their ankle, another staff member offered to lift said staff member on their back and take them to their destination. Staff members, in interviews with the LPA, denied this allegation and stated no one was giving rides to a staff member in the hallways. In interviews with residents, one resident confirmed they had seen a staff member giving a piggyback ride to another staff member. This resident did not know the reason for the piggyback ride and did not state it posed a risk to the residents. After review, this allegation is unsubstantiated.

Concerning the allegation of facility staff mishandling the food of residents, LPA interviewed the Administrator, staff members, and residents. The Administrator denied this allegation in an interview and stated they had never received reports of food being mishandled by staff. In interviews with facility staff, staff members stated they have never mishandled food or witnessed food be mishandled or denied to residents. In resident interviews, there was not an affirmation of food being mishandled by staff. After review, this allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with the Administrator over the phone. The Administrator will receive this LIC9099 report through email or mail to sign and then will email or mail the signed version back to the LPA.
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Mohamed Filouane
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2