Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 389210019
Report Date: 09/05/2019
Date Signed 09/05/2019 11:50:22 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:SAN FRANCISCO ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
389210019
ADMINISTRATOR:JOANNA CHEUNGFACILITY TYPE:
735
ADDRESS:887 POTRERO AVE.TELEPHONE:
(415) 206-6300
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:55CENSUS: 32DATE:
09/05/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Joanna Cheung and Linda SimsTIME COMPLETED:
11:55 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
Licensing Program Analyst (LPA) Michael Garcia conducted an unannounced case management-legal/non-compliance inspection to monitor facility compliance with regulations. LPA met with Joanna Cheung, administrator, and Linda Sims, director. LPA explained to Joanna Cheung and Linda Sims that the facility is not on probation and not restricted to not admit residents.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Michael GarciaTELEPHONE: (650) 380-4608
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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