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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002728
Report Date: 10/17/2019
Date Signed: 10/17/2019 12:41:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SOJOURNER TRUTH CENTERFACILITY NUMBER:
384002728
ADMINISTRATOR:ALCANTARA, TELMAFACILITY TYPE:
850
ADDRESS:1 CASHMERE STREETTELEPHONE:
(415) 401-1379
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:45CENSUS: 29DATE:
10/17/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Telma AlcantaraTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Singh, met with director, Telma Alcantara, for a case management inspection. The purpose of the inspection was explained. This facility has random annual inspection done on September 04, 2019. During the inspection on that day, LPA met with Training Volunteer Supervisor (TVS), Phyllis Hogan. At that time, TVS’s criminal background clearance was not associated to this facility and a type A deficiency was cited and civil penalty was assessed. After record review at the office, Licensing Program Manager (LPM) Zebila made the decision to remove the citation and civil penalty. After consulting with LPM, LPA Singh amended the previously issued report. During today’s inspection, LPAs acquired the signature on the amended report and provided the copy to the director. LPAs informed the director that All individuals subject to a criminal record review and have association establish to the facility prior to working, residing, or volunteering in a licensed facility

Copy of this report is reviewed and provided to the director. No deficiencies are cited today. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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