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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600423
Report Date: 02/23/2024
Date Signed: 02/23/2024 02:56:24 PM


Document Has Been Signed on 02/23/2024 02:56 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: 62DATE:
02/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennine Chan, Assistant Executive DirectorTIME COMPLETED:
03:00 PM
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On February 23, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a case management health and safety inspection. LPA Calandra met with Jennine Chan, Assistant Executive Director and explained the purpose of his visit.

During the visit, LPA Calandra toured the physical plant. LPA Calandra toured the facility kitchen, living and dining room, and 3 floors. LPA Calandra observed that the facility had sufficient perishable and non-perishables on hand and the community was observed to be in good physical condition.

LPA Calandra also spoke with Stephanie Hall, Executive Director via the phone.

LPA Calandra interviewed 2 residents and 2 staff.

No deficiencies were cited during today's visit. The report was reviewed with Jennine Chan, Assistant Executive Director and a copy was emailed to Jennine. LPA confirmed receipt of email prior to leaving the facility.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
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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