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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601080
Report Date: 05/11/2023
Date Signed: 05/30/2023 04:20:42 PM


Document Has Been Signed on 05/30/2023 04:20 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:VISTA TERRACE OF BELMONTFACILITY NUMBER:
415601080
ADMINISTRATOR:JOAN JOHNSONFACILITY TYPE:
740
ADDRESS:900 SIXTH AVENUETELEPHONE:
(650) 591-2008
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:68CENSUS: 0DATE:
05/11/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Management Company, Integral Senior LivingTIME COMPLETED:
02:00 PM
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On May 11, 2023, San Bruno Regional Office conducted a Microsoft Teams meeting with Integral Senior Living (ISL) Management along with the Santa Rosa and Oakland Regional Office. During this meeting, ISL discussed the status of the electrical issues, options that will be provided to families and residents due to the delay in reopening, how to coordinate and track residents if they plan to move to other communities or need belongings from Vista Terrace of Belmont.

Present in this meeting was Assistant Program Administrator, Stacy Barlow, Regional Manager, Vivien Helbling, Licensing Program Manager, Cara Smith, Licensing Program Analyst, Komal Charitra from the San Bruno Regional Office, Regional Manager, Issac Taggart, Licensing Program Manager, Yvonne Flores from the Oakland Regional Office, Licensing Program Manager, Bethany Moellers from the Santa Rosa Regional Office, and San Mateo Long Term Care Ombudsman, Tom Barrett.

In addition, present in this meeting from ISL was Senior VP of Operations, Mike Zeug, Senior VP of Sales/Marketing, Jeffrey Smith, VP of Human Resources, Cathy Battles, , Director of Operational Services, Cossondra Blair, Director of Project Management, Tara Weitor, Executive Director at Vista Terrace of Belmont, Joan Johnson and additional representatives from ISL. In addition, attorney Joel Goldman from Hanson Bridgett was present.

During this meeting the following was discussed; 4-6 month timeline for facility electrical repairs, communication with family members regarding delay in repair and the options residents and families will receive, coordinating moving the rest of the residents' belongings from Vista Terrace to their new location, and ongoing status updates that will be provided to CCL, residents and families regarding the electrical repairs.

--Licensee to submit the following requested items to CCL; copies of electrical reports/repairs from January 2023 and a copy of electrical report from April 2023 with timelines of required repairs.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
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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