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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600423
Report Date: 01/31/2024
Date Signed: 01/31/2024 02:49:52 PM

Document Has Been Signed on 01/31/2024 02:49 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SAGEBROOK SENIOR LIVING AT SAN FRANCISCOFACILITY NUMBER:
385600423
ADMINISTRATOR:FAIMAFILI HOWARDFACILITY TYPE:
740
ADDRESS:2750 GEARY BLVDTELEPHONE:
(415) 346-0246
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 111CENSUS: 64DATE:
01/31/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:Faimafili Igafo, Executive DirectorTIME COMPLETED:
03:00 PM
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On January 31, 2024 at 8:17 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to continue the Annual 1-year required inspection. LPA Calandra was greeted by Juvy Valera, Concierge at the door and explained the purpose of his visit. Faimafili Igafo, Executive Director joined the visit later.

LPA Calandra interviewed 3 staff and 4 residents.

LPA Calandra reviewed 5 resident records which were observed to be complete and 5 staff records which were all observed to be complete.

No deficiencies were cited during today's visit. The report was reviewed with Faimafili Igafo, Executive Director and a copy left at the facility.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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