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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600125
Report Date: 12/04/2020
Date Signed: 12/14/2020 04:35:45 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:RHODA GOLDMAN PLAZAFACILITY NUMBER:
385600125
ADMINISTRATOR:IRA KURTZFACILITY TYPE:
740
ADDRESS:2180 POST STREETTELEPHONE:
(415) 345-5060
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY:195CENSUS: 130DATE:
12/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Adrienne FairTIME COMPLETED:
05:30 PM
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LPA Jeung conducted virtual FaceTime Tele-visit with assistant executive director to discuss Incident Report received 12/3/20 that involved alleged financial abuse of a client.

LPA observed client's MD report and appraisal, and copies will be faxed to LPA.

LPA advised Ms. Fair that privately paid caregivers and companions must have criminal record clearance and be associated to facility, even if they are provided through a caregiver agency.

No deficiencies are cited today.





*****This report is emailed to Ms. Fair, who is requested to sign report and return to LPA via fax or email******
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020
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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