Community Care Licensing

Document Has Been Signed on 09/13/2023 06:01 PM - It Cannot Be Edited

FACILITY NAME:	SUTRO HEIGHTS CORPORATION		FACILITY NUMBER:	385601097
ADMINISTRATOR:	PACALDO, JULIET		FACILITY TYPE:	740
ADDRESS:	659 45TH STREET		TELEPHONE:	(415) 571-8531
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY: 14		CENSUS: 11	DATE:	09/13/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Shirley Aguado, Julio Yap, Charlene & Laymer Pamintuan		TIME COMPLETED:	06:15 PM

SUPERVISORS NAME: Cara Smith LICENSING EVALUATOR NAME: Audrey Jeung LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023

Link to Parent Document Below:

FACILITY NAME: SUTRO HEIGHTS CORPORATION	FACILITY NUMBER: 385601097
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/14/2023 Section Cited CCR 87303(i)(1)	1 2 3 4 5 6 7	MAINTENANCE AND OPERATION Facilities shall have signal systems which shall meet the following criteria: ...having separate floors or buildings shall have a signal system which shall operate from each resident's living unit, transmit a visual and/or auditory signal to a central staffed location or produce an auditory	1 2 3 4 5 6 7	Emergency call system shall be installed and operable in each clients' room, identify the room of origin and transmit auditory alert to summon staff. Proof of correction to be submitted to CCLD BY DUE DATE
	8 9 10 11 12 13 14	signal at the living unit loud enough to summon staff, identify the specific resident living unit. This requirement is not met, as 3 out of 5 rooms on ground floor and 4 out of 5 rooms on 2nd floor do not have call system. Licensee failed to ensure that emergency call system is installed, which poses an immediate health & safety risk to clients in care.	8 9 10 11 12 13 14
Type A 09/14/2023 Section Cited CCR87204(a)(b)	1 2 3 4 5 6 7	LIMITATIONS CAPACITY/AMBULATORY STATUS A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including... Resident rooms approved for 24-hour care of ambulatory residents only shall	1 2 3 4 5 6 7	Plan/proof of correction to be sent to CCLD BY DUE DATE
	8 9 10 11 12 13 14	not accommodate nonambulatory residents. This requirement is not met, as client #1 is non-ambulatory and resides in room on 2nd level. Licensee failed to adhere to limitations of ambulatory status, which poses an immediate health and safety risk to clients in care	8 9 10 11 12 13 14

SUPERVISOR'S NAME: Cara Smith LICENSING EVALUATOR NAME: Audrey Jeung LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023

Link to Parent Document Below:

FACILITY NAME: SUTRO HEIGHTS CORPORATION	FACILITY NUMBER: 385601097
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/20/2023 Section Cited CCR 87307(c)	1 2 3 4 5 6 7	PERSONAL ACCOMMODATIONS AND SERVICES Individual privacy shall be provided in all toilet, bath and shower areas. This requirement is not met, as commode is in use in 2nd floor shared room of client #1.	1 2 3 4 5 6 7	Plan/proof of correctuion to be sent to CCLD by DUE DATE
	8 9 10 11 12 13 14	Licensee failed to ensure privacy when toiletting for clients in shared room, which poses a potential health, safety or personal rights risk to clients in care.	8 9 10 11 12 13 14
Type B 09/20/2023 Section Cited CCR87465	1 2 3 4 5 6 7	INCIDENTAL MEDICAL CARE (h)(6) A record of centrally stored Rx medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started	1 2 3 4 5 6 7	Plan/proof of corrections to be submitted to CCLD BY DUE DATE
	8 9 10 11 12 13 14	& expiration, prescription number and instructions: This requirement is not met, as there is no Centrally Stored Medication Records for staff #1 and #2. Licensee failed to ensure that CSMR is maintained for clients' medications, which poses a potential health, safety or personal rights risk to clients.	8 9 10 11 12 13 14

SUPERVISOR'S NAME: Cara Smith LICENSING EVALUATOR NAME: Audrey Jeung LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023