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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385601097
Report Date: 04/02/2024
Date Signed: 04/02/2024 06:21:53 PM

Document Has Been Signed on 04/02/2024 06:21 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:SUTRO HEIGHTS CORPORATIONFACILITY NUMBER:
385601097
ADMINISTRATOR:PACALDO, JULIETFACILITY TYPE:
740
ADDRESS:659 45TH STREETTELEPHONE:
(415) 571-8531
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 14CENSUS: 9DATE:
04/02/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
04:32 PM
MET WITH:Laymer Pamintuan, Charlene Pamintuan, AdministratorsTIME COMPLETED:
06:30 PM
NARRATIVE
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On April 2, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 4:32 PM, to complete the Annual Inspection. LPA Calandra was greeted by Julio Yapp, Caregiver and explained the purpose of his visit. Charlene Pamintuan and Laymer Pamintuan, Administrators arrived later during the visit.

LPA Calandra toured the physical plant and observed that the backyard fence was in severe disrepair and leaning in towards the facility. LPA Calandra also observed wooden boards in the outside passageway obstructing the facility's emergency exit.

LPA interviewed 3 residents and 3 staff.

Type B citations were provided for the backyard fence and wooden boards.

Deficiencies are cited under the California Code of Regulations. Failure to correct said deficiencies may result in additional civil penalties.

This report was reviewed with Charlene Pamintuan, Administrator and a copy of the report along with appeal rights was left at the facility.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024
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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Document Has Been Signed on 04/02/2024 06:21 PM - It Cannot Be Edited


Created By: John Calandra On 04/02/2024 at 04:44 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: SUTRO HEIGHTS CORPORATION
FACILITY NUMBER: 385601097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
87303(a) Maintenance and Operations:
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation of a side fence in the backyard that was in severe disrepair and leaning towards the facility, the licensee did not comply with the section cited above in 1 out of 1 backyard fences, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Licensee/Administrator to submit proof of correction and a written plan outlining how this violation will be avoided in the future to licensing office by due date.
Type B
Section Cited
CCR
87303(a)
87303(a) Maintenance and Operations
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation of wood boards leaning against wall of the emergency exit/passage on the side of the house, the licensee did not comply with the section cited above in 1 out of 1 wood boards which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/16/2024
Plan of Correction
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Licensee/Administrator to submit proof of correction and a written plan outlining how this violation will be avoided in the future to licensing office by due date.
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:Cara Smith
LICENSING EVALUATOR NAME:John Calandra
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2024


LIC809 (FAS) - (06/04)
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