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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385601045
Report Date: 04/24/2025
Date Signed: 04/24/2025 10:42:12 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
01/24/2025 and conducted by Evaluator Yi Sam Jian
COMPLAINT CONTROL NUMBER: 14-AS-20250124101153
FACILITY NAME:PORTOLA GARDENSFACILITY NUMBER:
385601045
ADMINISTRATOR:GREGORY K BOGARTFACILITY TYPE:
740
ADDRESS:350 UNIVERSITY STTELEPHONE:
(415) 337-1587
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:104CENSUS: 92DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Greg BogartTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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-Resident sustained injury due to lack of supervision.
-Facility failed to conduct reappraisal of resident after significant change in resident's physical, mental, cognitive, behavioral, or functional condition.
INVESTIGATION FINDINGS:
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On 04/24/2025, Licensed Program Analyst (LPA) Yi Sam Jian arrived at the facility to deliver conclusionary finding for this complaint received by the Department on 01/24/2025. LPA was greeted by administrator Greg Bogart and explained the purpose of the visit.
Regarding the allegation that Resident sustained injury due to lack of supervision, client’s care, supervision and services were not adjusted in December 2024 to prevent harm to other client, despite documented incidents of client exhibiting harm toward staffs in December 2024.
Regarding the allegation that facility failed to conduct reappraisal of resident after significant change in resident's physical, mental, cognitive, behavioral, or functional condition, client was not reappraised after documented incidents of exhibiting harm to staffs.
Based on interviews and file reviews during the course of the investigation it was determined that the preponderance of evidence standard has been met, therefore the allegations above are found to be SUBSTANTIATED.
The deficiency is cited in accordance with California Code of Regulations, Title 22 Division 6, Chapter 8 and is noted on the attached LIC 9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
01/24/2025 and conducted by Evaluator Yi Sam Jian
COMPLAINT CONTROL NUMBER: 14-AS-20250124101153

FACILITY NAME:PORTOLA GARDENSFACILITY NUMBER:
385601045
ADMINISTRATOR:GREGORY K BOGARTFACILITY TYPE:
740
ADDRESS:350 UNIVERSITY STTELEPHONE:
(415) 337-1587
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:104CENSUS: 92DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Greg BogartTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
-Facility made false claims or misleading statement to Licensing Department.

INVESTIGATION FINDINGS:
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Regarding facility made false claims or misleading statement to Licensing Department. No evidence of false claims or misleading statement was found from the incident report reviewed.

The Department has investigated the above allegations. The allegations are 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20250124101153
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PORTOLA GARDENS
FACILITY NUMBER: 385601045
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2025
Section Cited
CCR
87468(a)(4)
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Personal rights requirement: To care, supervision, and services that meet their individual needs

This requirement was not met, as evidenced by file reviews and interviews revealed that the client’s care,
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Administrator agreed to submit proof of correction with a written plan outlining how this violation will be avoided in the future to licensing office by 04/25/2025. Failure to correct this deficiency by due date may result in a civil penalty
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supervision and services were not adjusted to prevent harm to other client, despite documented incidents of client exhibiting harm toward staffs. This violation poses an immediate health and safety risk to residents in care.
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Type A
04/25/2025
Section Cited
CCR
87463(b)(1)(C)
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Reappraisals requirement: The reappraisal shall document significant changes in…Behavioral expression…that may result in harm to self or others.
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Administrator agreed to submit proof of correction with a written plan outlining how this violation will be avoided in the future to licensing office by 04/25/2025. Failure to correct this deficiency by due date may result in a civil penalty
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This requirement was not met, as evidenced by file reviews and interviews, which revealed that the client was not reappraised after documented incidents of exhibiting harm to staffs. This violation poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3