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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601116
Report Date: 02/23/2022
Date Signed: 02/23/2022 01:54:00 PM


Document Has Been Signed on 02/23/2022 01:54 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:COTERIE CATHEDRAL HILLFACILITY NUMBER:
385601116
ADMINISTRATOR:LALOYAN,SIRUN SARAHFACILITY TYPE:
740
ADDRESS:1001 VAN NESS AVENUETELEPHONE:
(415) 915-6615
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:260CENSUS: 0DATE:
02/23/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Sarah LaloyanTIME COMPLETED:
02:00 PM
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On 2/23/22 at 10:30AM, Licensing Program Analyst (LPA), Murial Han met with the Administrator, Sarah Laloyan to conduct an announced Pre-Licensing inspection. LPA Han was properly screened for COVID-19 at the front entry.

LPA observed the indoor and the outdoor passageways are free of obstruction.

The Administrator provided a tour of the facility.


This is a 14-story level facility with a roof top and excluding a 13th floor. The facility has one bed- room studios and two bed-room apartments. The Memory Care Unit is located on the 4th floor with a total of 33 rooms- 30 single apartments and 3 shared apartments.

There is no residents during the inspection. The overall facility is observed to be spacious, cleaned, comfortable temperature and good lighting. The temperature was measure at 70- 76 degrees Fahrenheit (F) and each apartment/studio has a thermostat for the residents to adjust the temperature of their preference.

The living rooms, the cinema room, the dinning rooms observed to be comfortable, spacious with adequate furniture. The Activities rooms are equipped with different activities for the residents.

The outdoor space is spacious with variety of activities. Emergency exiting plans are posted on every floor.

LPA observed COVID-19 signs through-out the facility. There are hand-washing signs posted at each bathroom sink. The water temperature at varies locations- bathrooms, shower rooms, kitchens, etc were measure at 106.2- 118 degrees F. LPA did not observe any toxic, chemicals, disinfectants to be accessible to the residents. There are sufficient lighting in the hallways. LPA observed the elevator permit is current from 12/2/2021- 12/2/2022.

SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: COTERIE CATHEDRAL HILL
FACILITY NUMBER: 385601116
VISIT DATE: 02/23/2022
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The facility has a fitness/yoga room for the residents with different exercise equipment and the door is operated by a card key which is a way to notify the facility staff when a resident enters the room so care and supervision can be provided while the resident(s) is using the room. In addition, the fitness/yoga room is equipped with a bathroom/shower room.

During the tour, the rooms that LPA observed were cleaned, spacious, good lighting and the temperatures were measured at 70-76 F. There was no bathtubs in any of the rooms but each apartment/studio has a shower room that is equipped with grab bars.

The Memory Care Unit entrance is operated by a card key. The environment is calm with comfortable music and lighting. There is a dedicated locked medication room in the unit for medication, resident's records, documentation devices, etc. There is a kitchenette with multiple locked drawers for storage supplies including but not limiting to sharps, plates, cups, etc. The fire extinguisher and the Ansel system were inspected on 12/1/21. LPA observed adequate plates, utensils and cook wares in the kitchen.

The facility has a main medication room that is located on the 2nd floor and the set-up is very similar to the medication room on the Memory Care Unit.

The facility has a swimming pool that is located on the 11th floor and the entrances are locked/card key controlled. In addition, the door closes automatically after opening and closing.

LPA observed the following postings, Resident Rights, Ombudsman Poster, Certification Licensing Complaint Poster, and Theft and Loss Program.

LPA observed the PPE supplies are stored on the 7th floor storage room and the staff reported that they are also stored on each floor.

Comp III orientation was given to the Administrator, Sarah Laloyan.

Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau.

Exit interview conducted with the Administrator, Sarah Laloyan and A copy of the report is provided.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2