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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600270
Report Date: 04/20/2021
Date Signed: 04/22/2021 03:17:20 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:ALMA VIA OF SAN FRANCISCOFACILITY NUMBER:
385600270
ADMINISTRATOR:BENITO DEL TOROFACILITY TYPE:
740
ADDRESS:ONE THOMAS MORE WAYTELEPHONE:
(415) 337-1339
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:175CENSUS: 104DATE:
04/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director, Benito Del ToroTIME COMPLETED:
03:10 PM
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On 4/20/2021, LPA Han conducted an unannounced Case Management Inspection in response to an incident that was reported by the facility on 4/15/2021. The facility reported that while moving resident #1's (R1) lamp that was near the bed, it fell and bump R1's head.

Due to the Pandemic, LPA Han has conducted this inspection remotely.

LPA Han spoke to the Executive Director, Benito Del Toro regarding the incident and requested for the following documents:

- Most recent Physician Report
- Current Service Plan
- Medical Records
- Any relevant facility records pertaining to the incident

This report was reviewed and discussed with the Executive Director. This report will be emailed to the Executive Director for a signature then returned to LPA Han along with the requested documents by noon on 4/21/2021.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
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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