385601084-6-4-2021-14-AS-KHOS-C5CQNQ-20210728121931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385601084
Report Date: 06/04/2021
Date Signed: 06/04/2021 12:54:28 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
05/17/2021 and conducted by Evaluator Mohamed Filouane

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20210517093843

FACILITY NAME:	LYNNE & ROY M FRANK RESIDENCES		FACILITY NUMBER:	385601084
ADMINISTRATOR:	POWONDRA, MATTHEW R		FACILITY TYPE:	740
ADDRESS:	ONE AVALON AVENUE		TELEPHONE:	(415) 469-2359
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	220	CENSUS: 71	DATE:	06/04/2021
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Edwina Tang		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Lack of supervision resulting in resident eloping from facility.
Facility is not maintaining a comfortable temperature for resident's.
Staff not safeguarding resident's personal belongings.
Facility not allowing resident to choose a healthcare provider of their choice.
Staff are not properly trained.

INVESTIGATION FINDINGS:

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On 06/04/21, Licensing Program Analyst (LPA) Mohamed Filouane conducted a follow-up complaint inspection on-site visit with Executive Director (ED) Edwina Tang and Director of Campus Programs (DCP) Robert Sarison. LPA explained the purpose of the visit and delivered the findings.

Concerning the allegation of lack of supervision resulting in a resident eloping from the facility, LPA Filouane interviewed the ED and the DCP as well as reviewed the submitted incident reports. The elopement of a resident occurred during a program event at the facility on 04/27/21. The facility reported that the resident was found safely and brought back within a few minutes. The facility submitted the required incident report on 04/30/21 to the Community Care Licensing Division (CCLD). According to Title 22 regulations, Section 87775, the facility has addressed this wandering safety concern by moving all programming to a more secured location in the facility. After review, this allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Mohamed Filouane
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 14-AS-20210517093843

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: LYNNE & ROY M FRANK RESIDENCES	FACILITY NUMBER: 385601084
	VISIT DATE: 06/04/2021

NARRATIVE

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Concerning the facility not maintaining a comfortable temperate for residents, during the LPA's on site 10-day visit, LPA Filouane verified the facility's temperature on multiple floors in the hallways. The facility had a constant temperature reading of 68 degrees Fahrenheit. According to Title 22 regulations, a facility shall heat rooms to a minimum temperature of 68 degrees Fahrenheit. Title 22 regulations also state that nothing shall prohibit residents from adjusting individual thermostatic controls. After review, this allegation is unsubstantiated.

Concerning the allegation of the facility not safeguarding a resident's personal belongings, LPA Filouane reviewed the incident report submitted to CCLD along with police reports of two residents who reported their belongings were stolen. Police reported to the facility that the theft could not be substantiated as there was a lack of information, details regarding the number of items, and evidence. The resident reporting the theft could not verify additional information about the alleged stolen items to the police. The facility has a theft and loss program enacted as required by Title 22 and has reported to the required entities. After review, this allegation is unsubstantiated.

Concerning the allegation of the facility not allowing residents to choose a healthcare provider, this facility is an Assisted Living facility, which assists residents in living independently. During an interview with the DCP, the DCP stated the facility recommends a healthcare provider to residents who are from out of the area searching for healthcare but does not require a certain provider. After review, this allegation is unsubstantiated.

Concerning the allegation of staff not properly trained, LPA Filouane observed staff at work during the on-site visit. During an interview with the ED and DCP, LPA requested training records of staff members to review. LPA reviewed the training records of Licensed Vocational Nurses, Medical Technicians, and Caregivers, and LPA observed current training. 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.

This report was reviewed and discussed with the Executive Director and Director of Campus Programs.

SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Mohamed Filouane
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

LIC9099 (FAS) - (06/04)

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