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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500295
Report Date: 06/20/2024
Date Signed: 06/20/2024 03:36:01 PM


Document Has Been Signed on 06/20/2024 03:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:HERITAGE ON THE MARINAFACILITY NUMBER:
380500295
ADMINISTRATOR:MARY LINDEFACILITY TYPE:
741
ADDRESS:3400 LAGUNA ST.TELEPHONE:
(415) 202-0300
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94123
CAPACITY:109CENSUS: 83DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Martha Nkhoma, Executive Director of Resident Health and Mary Linde, Chief Executive Officer TIME COMPLETED:
03:30 PM
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On June 20, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:30 AM, to conduct the unnanounced Annual 1-year required Inspection. LPA Calandra was greeted by Martha Nkhoma, Executive Director of Resident Health and explained the purpose of the visit. Mary Linde, Chief Executive Officer joined the visit later.

LPA Calandra toured the physical plant. This is a 3 story building with 84 bedrooms and bathrooms, front and backyards, courtyard, kitchen, and activities room. All bedrooms had the required furniture and were sufficiently lit. Fire Extinguishers were last checked on November 11, 2023 and were observed to be fully charged. Fire alarms and Carbon Monoxide detectors were observed to be in working condition. No accessible bodies of water were observed in hallways or yards. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. Hot water temperature was measured between the required 105-120 degrees Fahrenheit. The facility had the required 7 days of non-perishables and 2 days of perishables on site. No food was expired.

LPA Calandra reviewed 6 resident records. All were observed to be complete.

The Annual will be completed at a later date.

No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Mary Linde, Chief Executive Officer and Martha Nkhoma, Executive Director of Resident Health.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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