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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
385601084
Report Date:
09/30/2022
Date Signed:
09/30/2022 05:50:19 PM
Document Has Been Signed on
09/30/2022 05:50 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:
LYNNE & ROY M FRANK RESIDENCES
FACILITY NUMBER:
385601084
ADMINISTRATOR:
TANG, EDWINA
FACILITY TYPE:
740
ADDRESS:
ONE AVALON AVENUE
TELEPHONE:
(415) 562-2855
CITY:
SAN FRANCISCO
STATE:
CA
ZIP CODE:
94112
CAPACITY:
220
CENSUS:
116
DATE:
09/30/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:30 PM
MET WITH:
Edwina Tang
TIME COMPLETED:
06:00 PM
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LPA Jeung met with executive director and obtained information about COVID cases that were reported to CCLD by email on 9/22/22. There are no new staff or residents infected with COVID.
LPA also toured facility as part of annual inspection. See Facility Evaluation Report (LIC809).
Staff work schedule for the week and client rosters by name and room number are given to LPA.
No deficiencies observed today.
SUPERVISORS NAME
:
Jackie Jin
LICENSING EVALUATOR NAME
:
Audrey Jeung
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/30/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/30/2022
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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