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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601084
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:28:48 PM

Document Has Been Signed on 09/19/2024 02:28 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:LYNNE & ROY M FRANK RESIDENCESFACILITY NUMBER:
385601084
ADMINISTRATOR/
DIRECTOR:		TANG, EDWINAFACILITY TYPE:
740
ADDRESS:ONE AVALON AVENUETELEPHONE:
(415) 562-2855
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY: 220CENSUS: 170DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Robert SarisonTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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LPA Yi Sam Jian and Dominic Tobola toured facility and grounds, consisting of studio, 1-bedroom and 2-bedroom units on 5 floors.

1st floor had Assisted living rooms, kitchen, common use rooms for the assisted living residents--lounges, dinning rooms, theater, performance center, cafe, salon, and fitness center, including locked indoor pool.

2nd, 3rd, 4th floor had assisted living room and memories care rooms. 5th floor had assisted living rooms only. In each of the memory care units, there is at least one dedicated dining room and outdoor space. The building accommodates residents, including non-ambulatory, bedridden and hospice residents. Rooms are equipped with emergency call systems, which can be activated from bathrooms and bedrooms.

2 outdoor courtyards, accessible from 1st floor, had no accessible body of water. Kitchen and food supplies are inspected. Infection control practices are reviewed. PPE supply is adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, hot water temperature inspected to be compliant, and lighting is sufficient for comfort and safety.

Fire safety equipment checked and fully charged. Facility van's first-aid kit and fire extinguisher inspected and complete. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed.

No deficiency cited today. The report is reviewed with administrator Edwina Tang and a copy is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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