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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601045
Report Date: 02/25/2025
Date Signed: 02/25/2025 05:16:01 PM

Document Has Been Signed on 02/25/2025 05:16 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:PORTOLA GARDENSFACILITY NUMBER:
385601045
ADMINISTRATOR/
DIRECTOR:		GREGORY K BOGARTFACILITY TYPE:
740
ADDRESS:350 UNIVERSITY STTELEPHONE:
(415) 337-1587
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY: 104CENSUS: 92DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Navpreet Kaur, Gregory BogartTIME VISIT/
INSPECTION COMPLETED:
05:27 PM
NARRATIVE
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On 02/25/2025, Licensing Program Analyst (LPA) Yi Sam Jian, Grace Donato and Licensing Program Manager (LPM) April Cowan arrived at the facility to conduct the unannounced required 1 year annual inspection visit. LPAs and LPM met with Health and Wellness Director, Navpreet Kaur, LPA explained the purpose of the visit. Administrator Gregory Bogart arrived later during the visit.

LPAs and LPM toured facility, which consists of shared and private studio apartments--all of which include sink and vanity--on ground and 2nd floors of this 3- story community. Each room has an emergency pull alarm, which transmits audio and visual signal to monitors in medication room and front desk. Thirty apartments are inspected. Common areas include lobby, sun room, dining room and expansive outdoor space, which includes level patio. There is one elevator and 5 interior stairwells, plus 2 exterior fire exit stairs. There are no accessible bodies of water or fire safety hazards observed. Medications are stored in locked medication room on 2nd floor and chemicals are stored in locked rooms. A comfortable temperature is maintained and passageways are clear.
Hot water temperature checked in bed rooms and common bathrooms within range of 105 - 118 degrees F.
There are at least 16 full bathrooms that are equipped with grab bars and nonskid flooring material. Food supply and first-aid kit are inspected.
Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Staff records, including training were reviewed.

Deficiencies of the California Code of Regulations, Title 22, are cited on following pages, per record review made today. Report was reviewed with Administrators, copy of report and Appeal Rights are provided
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 2
Document Has Been Signed on 02/25/2025 05:16 PM - It Cannot Be Edited


Created By: Yi Sam Jian On 02/25/2025 at 04:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PORTOLA GARDENS
FACILITY NUMBER: 385601045

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(3)
A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

This requirement is not met, as MD orders are not maintained for half bed rails for 4 clients which poses a potential health, safety or personal rights risk to clients. Client#1, #2, #3, and #4 are missing MD orders for half bed rails.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 10 residnets did not have MD orders for haf bed rails in their files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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MD orders for half bed rails for clients #1, #2, #3, and #4 will be sent to CCLD. MD orders should be maintained for all clients who use half bed rails. Plan/proof of correction to be sent to CCLD BY DUE DATE
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Andrea Medlin
LICENSING EVALUATOR NAME:Yi Sam Jian
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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