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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600385
Report Date: 06/15/2023
Date Signed: 06/15/2023 02:58:56 PM


Document Has Been Signed on 06/15/2023 02:58 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CORINTHIAN GARDEN RESIDENTIAL CARE HOMEFACILITY NUMBER:
385600385
ADMINISTRATOR:ENCARNACION, WILLIAM S.FACILITY TYPE:
740
ADDRESS:170 APTOS AVENUETELEPHONE:
(415) 841-0311
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY:6CENSUS: DATE:
06/15/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee/Administrator, William EncarnacionTIME COMPLETED:
03:00 PM
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On June 15, 2023 San Bruno Regional Office conducted a non-compliance conference meeting with Licensee/Administrator, William Encarnacion.

Present in the meeting was Regional Manager, Vivien Helbling, Licensing Program Managers, Cara Smith and Jackie Jin, and Licensing Program Analysts, Komal Charitra and Murial Han. Also present in the meeting was Local Long Term Care Ombudsman, Benson Nadell and Luis Calderon from San Francisco Department of Public Health.

During non-compliance meeting, the following violations were discussed: Storage Space, Personal Accommodations and Services, Alterations to Existing Building or New Facilities, and Fire Safety.

During this meeting, it was discussed, Community Care Licensing will increase frequency monitoring inspection visits to ensure compliance with this compliance plan of Title 22 regulation. Licensee was provided the link below for resources and guidance to improve facility operations:
https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers

Report is reviewed with the Licensee and a copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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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