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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601039
Report Date: 06/08/2023
Date Signed: 06/08/2023 05:31:20 PM


Document Has Been Signed on 06/08/2023 05:31 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CADENCE MILLBRAEFACILITY NUMBER:
415601039
ADMINISTRATOR:STROMGREN, KIELFACILITY TYPE:
740
ADDRESS:1201 BROADWAYTELEPHONE:
(650) 742-9150
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:165CENSUS: 131DATE:
06/08/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Margaret Madrid and Michael SharkeyTIME COMPLETED:
05:30 PM
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LPA Jeung met with business office manager and executive director to discuss 8 recent move-ins from Belmont RCFE. LPA observed 2 apartments occupied by new residents and met one resident. Other than numerous boxes that needed to be unpacked, no health or safety issues are observed. Administrator is reminded to ensure that required admission documents are completed--admission agreement, physicians' report, appraisals, emergency information, etc.

LPA spoke with vice-president of operations and reminded her to submit documentation to designate Mr. Sharkey as administrator, including board resolution. Also discussed was the corporate organization, which added Cogir Corp. in December 2022.

No deficiencies are observed today.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Audrey JeungTELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
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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