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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601149
Report Date: 03/26/2024
Date Signed: 03/26/2024 03:53:39 PM


Document Has Been Signed on 03/26/2024 03:53 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:GENTLE HANDS SENIORSFACILITY NUMBER:
385601149
ADMINISTRATOR:BANGURA, FATMATAFACILITY TYPE:
740
ADDRESS:2447 19TH AVENUETELEPHONE:
(415) 564-6695
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:6CENSUS: DATE:
03/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Aminata Jalloh and Anica Koljenik, Caregivers, and Fatmata Bangura, Administrator/LicenseeTIME COMPLETED:
04:00 PM
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On March 26, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 12:30 PM, to conduct the Annual 1-year required inspection. LPA Calandra was greeted at the door by Aminata Jalloh, Caregiver and explained the purpose of his visit. Caregiver, Anica Koljenik and Fatmata Bangura, Administrator/Licensee joined the visit later.

LPA Calandra toured the physical plant. This is a 1 story building which consists of 7 bedrooms, 1 and a half bathrooms, a kitchen, living room, dining room, entry way and backyard. All hallways and the backyard were observed to be free and clear from obstructions. The fire extinguishers were last checked on 6/22/2023 and were observed to be fully charged. The facility's Carbon Monoxide and Fire Alarms were observed to be in working order. The facility was maintained at a comfortable temperature of 73 degrees Fahrenheit. Water temperature in the bathrooms was measured at 117.5 degrees Fahrenheit within the required range of 105-120 degrees Fahrenheit. The facility has the required 7 days of non-perishables and 2 days of perishables on hand. No food was observed to be expired. The Kitchen Refrigerator and Freezer were within the required temperature range.

All knives, sharp objects, and detergents/cleaning supplies were observed to be locked up and in-accessible to persons in care.

LPA Calandra reviewed 5 resident files. Most were observed to be complete.

The Annual Inspection will be completed at a later date.

Two Technical Violations were provided for not having an appraisal of resident's needs and services for each resident and not obtaining a recent medical assessment for a resident.

No deficiencies were cited during today's visit. This report was reviewed with Administrator/Licensee, Fatmata Bangura and a copy of the report left at the facility.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
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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