<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601101
Report Date: 05/18/2021
Date Signed: 05/18/2021 10:35:51 AM

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:AEGIS LIVING SAN FRANCISCOFACILITY NUMBER:
415601101
ADMINISTRATOR:HOWARD, FAIMAFILI (FILI)FACILITY TYPE:
740
ADDRESS:2280 GELLERT BLVDTELEPHONE:
(650) 242-4154
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:100CENSUS: 64DATE:
05/18/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Chris LyonsTIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 18, 2021 at 9:03am Licensing Program Analyst (LPA) Chris Hopkins conducted an announced pre-licensing inspection. LPA met and toured the facility with the Administrator Chris Lyons.

This is a four story facility. LPA observed public bathrooms on each floor. Client rooms are furnished with required lighting fixtures and furniture. LPA observed room 301, and bathroom was observed and in good repair and water temperature within regulation testing at 110 degrees Fahrenheit. LPA also observed room 102, and bathroom was observed and in good repair and water temperature within regulation testing at 106 degrees Fahrenheit. Dining room and kitchen observed, food supply adequate. Cleaning supplies stocked and locked in storage room. Courtyard is fenced and secured. No bodies of water observed. All outdoor and indoor passageways were free of obstruction. LPA observed Emergency exits. Medications are locked inside the wellness office located on the 2nd floor.

LPA observed fire extinguishers throughout the facility, located on each floor. Fire Extinguishers last serviced on May 5, 2021. Smoke and carbon monoxide combination detectors present throughout the facility. First aid kit is in place with required items.

The following posters/forms posted in the lobby: Emergency Disaster Plan, Emergency Telephone Numbers, Resident Personal Rights, and Licensing Complaint Poster (1-844-LET-US-NO). LPA observed staff files as current. Administrator certificate is observed as current expiring on 6/30/2021. Component III completed after tour of facility.

As a result of inspection today, the facility meets the physical plant requirements of California Code of Regulations, Title 22. Immediate licensure is recommended, pending final approval from the Central Applications Bureau.

No deficiencies cited. This report was discussed with Chris Lyons and a copy was given to her via email.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021
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 1