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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600235
Report Date: 03/12/2024
Date Signed: 03/12/2024 12:22:52 PM


Document Has Been Signed on 03/12/2024 12:22 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: 44DATE:
03/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Naoko Jones, Executive Director TIME COMPLETED:
12:30 PM
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On March 12, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 10:57 AM to conduct an unnanounced Case Management visit to assess a resident (R1), the facility had submitted a total care exception request for. LPA Calandra met with Naoko Jones, Executive Director and explained the purpose of his visit.

LPA Calandra observed R1 during a pre-scheduled appointment and while R1 eating lunch in the common dining room with a member of the care staff.

No deficiencies were cited during today's visit.

This report was reviewed with Naoko Jones, Executive Director 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: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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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