<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 385600235
Report Date: 07/22/2021
Date Signed: 07/22/2021 03:26:52 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/05/2020 and conducted by Evaluator Murial Han
COMPLAINT CONTROL NUMBER: 14-AS-20200305140351
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: 40DATE:
07/22/2021
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Executive Director, Naoko JonesTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-- Facility failed to conduct emergency preparedness drills.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/22/2021, on behave of Licensing Program Analyst Michael Garcia, Licensing Program Analyst (LPA) Han conducted an unannounced complaint visit to deliver the finding on the above allegations. LPA met the Executive Director, Naoko Jones.

According to records review conducted, on January 16, 2020, the facility was cited for failure to conduct a fire and earthquake drill at least once every three months. The facility’s Plan of Correction was received by CCL on January 19, 2020, and the deficiency was cleared.

CCL received the complaint on March 5, 2020. The facility was in compliance when the complaint allegation was received.

CONTINUE ON NEXT PAGE...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 14-AS-20200305140351
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KOKORO ASSISTED LIVING
FACILITY NUMBER: 385600235
VISIT DATE: 07/22/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
This agency has investigated the complaint alleging facility failed to conduct emergency preparedness drills. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2