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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600235
Report Date: 03/08/2024
Date Signed: 03/08/2024 02:57:10 PM


Document Has Been Signed on 03/08/2024 02:57 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:KOKORO ASSISTED LIVINGFACILITY NUMBER:
385600235
ADMINISTRATOR:NAOKO JONESFACILITY TYPE:
740
ADDRESS:1881 BUSH STTELEPHONE:
(415) 776-8066
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:61CENSUS: 45DATE:
03/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Angelina Esplana, Director of Marketing and AdministrationTIME COMPLETED:
03:15 PM
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On March 8, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:40 PM to conduct an unnanounced Case Management visit in regards to an Exception request submitted by the facility for a resident who the facility believes needs total care. LPA Calandra met with Angelina Esplana, Director of Marketing and Administration and explained the purpose of his visit. Executive Director, Naoko Jones and Sakae Hamilton, Director of Resident Care were off and unable to join the visit.

LPA Calandra met and interviewed R1 to assess the resident. Further details can be found on the 812.

LPA Calandra also interviewed staff tasked with caring for R1.

No deficiencies were cited during today's visit.

This visit will be continued at a later date.

The report was reviewed with Angelina Esplana, Director of Marketing and Administration and a copy of the report left at the facility.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024
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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