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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380540292
Report Date: 10/11/2022
Date Signed: 10/11/2022 03:56:55 PM


Document Has Been Signed on 10/11/2022 03:56 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SAN FRANCISCO TOWERSFACILITY NUMBER:
380540292
ADMINISTRATOR:CHRISTINA SPENCEFACILITY TYPE:
741
ADDRESS:1661 PINE STREETTELEPHONE:
(415) 776-0500
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:350CENSUS: 297DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Health Services Administrator, Ryan BannerTIME COMPLETED:
01:50 PM
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On 10/11/22, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was properly screened by the security officer at the entrance. LPA was greeted by health services administrator, Ryan Banner and LPA explained the purpose of today's visit.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident and staff daily monitoring records, containment strategies.

During the tour that was provided by the health services administrator, infection control preventionist and the assistant director of resident health services, LPA observed COVID-19 signs posted throughout the facility including the elevators, hand washing instruction is posted by the kitchen sinks (LPA reminded facility staff to post hand-washing instruction on other hand-washing stations), foot operated trash cans placed in multiple locations, hand sanitizer devices installed outside of each resident's room in the assisted living unit, PPE supply and the environmental cleaning supply are adequate, bathrooms are equipped with liquid soap and paper towels.

The memory care unit is located on the mezzanine level. There are 7 residents in unit. Exits are equipped with 30 second delayed egresses: one is tested and operates as required. Rooms (including assisted living) are equipped with emergency call systems, which can be activated from bathrooms and bedrooms.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAN FRANCISCO TOWERS
FACILITY NUMBER: 380540292
VISIT DATE: 10/11/2022
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Kitchen and food supplies are inspected. Refrigerators and freezers temperatures are inspected within required limits.

Medications, toxins and sharps are stored appropriately and inaccessible to resident, a comfortable temperature is maintained, lighting is sufficient for comfort and safety. First-aid kit is inspected and complete.

The following updated licensing forms and information are requested to be submitted to CCLD BY 10/18/22 to update the new administrator: written letter from the Licensee appointing the current administrator for the facility, administrator certification, LIC 500, LIC 501 and LIC 308.

No deficiency cited today. This report is reviewed and discussed with the infection control preventionist and the assistant director of resident health services. A copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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