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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601116
Report Date: 10/25/2023
Date Signed: 10/25/2023 11:34:05 AM


Document Has Been Signed on 10/25/2023 11:34 AM - 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: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: 124DATE:
10/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Shirley Cheung, Care Coordination Director, Sarah Laloyan, SVP of Operations, and Deborah Suarez, AGM TIME COMPLETED:
12:00 PM
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On October 25, 2023, Licensing Program Analyst(LPA), John Calandra and Licensing Program Manager(LPM), Cara Smith arrived at the facility to follow up in regards to an incident report received on September 21, 2023 regarding a resident who left the facility unattended. LPA Calandra and LPM Smith were greeted by Shirley Cheung, Care Coordination Director, Sarah Laloyan, Senior Vice President of Operations, and Deborah Suarez, Assistant General Manager and explained the purpose of their visit.

Shirley Cheung and Sarah Laloyan, informed the LPA and LPM that the resident had left the facility with other residents for a community walk with their spouse. The resident came back to the community and notified the front desk staff that they would like to continue their walk. The resident did not sign in or out via the Accushield system.This is not considered an abnormal practice based on an interview with Deborah Suarez, Assistant General Manager.

LPA Calandra and LPM Smith reviewed and collected several documents including the resident's LIC 602, list of activities for the day, notes regarding the incident, Absentee notification plan, etc.

At this time, there are no deficiencies cited. A copy of this report was reviewed with Shirley Cheung, Care Coordination Director, Sarah Laloyan, Senior Vice President of Operations, and Deborah Suarez, Assistant General Manager and left at the facility.


SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
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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