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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601097
Report Date: 03/15/2021
Date Signed: 04/12/2021 10:43:21 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SUTRO HEIGHTS CORPORATIONFACILITY NUMBER:
385601097
ADMINISTRATOR:PACALDO, JULIETFACILITY TYPE:
740
ADDRESS:659 45TH STREETTELEPHONE:
(650) 393-0265
CITY:SAN FRANSISCOSTATE: CAZIP CODE:
94121
CAPACITY:6CENSUS: 13DATE:
03/15/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Juliet PacaldoTIME COMPLETED:
12:00 PM
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On 3/15/21, at 11:00am, Licensing Program Analyst (LPA) Murial Han conducted a second pre-licensing inspection. Due to COVID-19 pandemic, the inspection was conducted remotely via Facetime video call. LPA conducted the tele-inspection with the Administrator, Juliet Pacaldo.

This inspection was to follow up the corrections that need to be made per initial pre-licensing inspection conducted on 3/11/2021.

LPA toured portions of the facility to inspect the areas that required corrections.

LPA observed and verified the corrections have been made as follows:
- Activity Calendar, Resident Rights, Menu, Resident Council Rights and Licensing
Complaint are posted.

- The chemical cabinet underneath the sink is fixed and locks properly.

- The staff are educated on the locations of the utility shut-offs and instructions are posted.

- The pathway to the backyard/garden is cleared and objects were moved in the garden.

- The Emergency Food Supplies- water is present.

As a result of inspection today, the pre-licensing area of concerns have been resolved. Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau.

An electronic copy of the report was emailed to Julie Pacaldo for signature.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
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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