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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600270
Report Date: 10/22/2021
Date Signed: 10/22/2021 02:35:18 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:ALAN FOXFACILITY TYPE:
740
ADDRESS:ONE THOMAS MORE WAYTELEPHONE:
(415) 337-1339
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:175CENSUS: 101DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator, Alan FoxTIME COMPLETED:
12:20 PM
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
On 10/22/2021, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA Han was properly screened for COVID-19 by the receptionist at front entrance. After the screening, LPA was greeted by the Administrator, Alan Fox and LPA explained the purpose of the visit.

LPA reviewed the following documents: daily monitoring and screening documents for residents, staff and visitors, Infection Control training records and N95 Fit Testing Training. The facility continues to conduct surveillance testing for all staff members on a monthly basis.

LPA toured the facility and observed a COVID-19 sign posted by the main entrance on mask and vaccination. LPA observed two signs posted throughout the facility: mask and the vaccination and hand-washing signs. The bathrooms have the hand-washing signs posted, foot operated lids, equipped with motion censor paper towel and liquid soap dispensers. LPA observed the tables are 6" apart in the dining room. There are hand sanitizer dispensers installed throughout the facility, the trash cans in the Memory Care Unit were observed to have foot operated lids, all the rooms in the Assisted Living are private and there are 2 bedroom apartments in the Memory Care Unit where residents have their own rooms but shared bathrooms. PPE supplies are adequate with isolation carts set-up and ready- to- go.

Recommendation- additional COVID-19 signs to be posted by the front entrance, elevator and through-out the facility; post 20 second hand-washing instruction signs in the public bathrooms, establish a system to ensure the public resident phone on the 1st floor is being cleaned and sanitized after each use.

No deficiency cited today. This report is reviewed and discussed with the Administrator. A copy will be emailed.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1