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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600277
Report Date: 11/30/2022
Date Signed: 08/01/2023 11:48:33 AM


Document Has Been Signed on 08/01/2023 11:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SFAL - THE AVENUEFACILITY NUMBER:
385600277
ADMINISTRATOR:WONG, TERESAFACILITY TYPE:
740
ADDRESS:1035 VAN NESS AVENUETELEPHONE:
(415) 776-1800
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:145CENSUS: 16DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Teresa WongTIME COMPLETED:
12:30 PM
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On 11/30/2022, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was greeted by administrator, Teresa Wong. LPA explained the purpose of the visit and LPA was screened at the front entrance.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident and staff daily monitoring records, containment strategies. LPA observed COVID-19 signs through-out the facility and hand washing signs were posted by the sinks. The furniture in the resident's dining rooms was observed to be 6" apart and only one resident is assigned per table. LPA observed residents were at least 6" apart during lunch time on the 2nd floor dining room. Food supply was checked and observed to be sufficient.

The facility has dedicated 1 room on the 8th floor for quarantine and isolation purposes and the room next door for donning and doffing with a foot operated garbage can inside the room. In addition, the facility has dedicated another private room on the 8th for family to stay during their visit if needed.

LPA observed staff break room to be spacious, 2 tables that are 6" apart and COVID-19 signs posted.

Medications, toxins and sharps are stored appropriately and inaccessible to resident, a comfortable temperature is maintained, lighting is sufficient for comfort.

There are 2 elevators at the facility with COVID-19 signs posted inside the elevator and hand sanitizer station set-up by the elevator..

No deficiency cited today. This report is reviewed and discussed with the administrator. A copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
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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