385601231-6-30-2026-14-AS-AJEG-DVJSKF-20260630135640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 385601231
Report Date: 06/30/2026
Date Signed: 06/30/2026 01:56:56 PM

Document Has Been Signed on 06/30/2026 01:56 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:	UPLYFT ASSISTED CARE LLC		FACILITY NUMBER:	385601231
ADMINISTRATOR/ DIRECTOR:	PAMINTUAN, LAYMER		FACILITY TYPE:	740
ADDRESS:	659 45TH AVE		TELEPHONE:	(415) 571-8877
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY: 14		CENSUS: 11	DATE:	06/30/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Lea Pantangco, Shirley Aguado, Charlene Pamintuan, Laymer Pamintuan		TIME VISIT/ INSPECTION COMPLETED:	02:00 PM

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	Applicant Uplyft Assisted Care LLC has submitted application for change of ownership of Residential Care Facility for the Elderly for 7 ambulatory and 7 non-ambulatory elderly residents. Fire clearance has been approved. Facility is currently licensed as Sutro Heights Corporation #385601097. LPA Audrey Jeung toured facility and grounds of this 3 story home, where clients reside in 4 ground floor and 4 second floor rooms. There are 2 full bathrooms, laundry room--where washer and dryer are located-- and a small dining area on the ground floor. The front bedroom is separated by a floor to ceiling curtain, creating 2 small semi-private rooms. On the second floor, there is a full bathroom with 2 shower stalls and a half bathroom, kitchen, dining room, foyer, and small office. There are 3 staff bedrooms on the top floor--one room has large bed for one staff, another room has a bunk bed for one staff, and another room has a bunk bed and another bed for 3 staff. The yard is level and fenced, and can be accessed by exterior stairs from the second floor; there is a storage shed in the yard that contains building materials. Bed and bath linens are observed, as well as cookware, dishes, and utensils for the preparation and service of food. Medications are stored appropriately and inaccessible to clients. Hot water temperature is tested in second floor bathroom. Carbon monoxide detectors are tested and operational. First-aid kit is inspected and complete. Hygiene items for general use and perishable and food supplies are maintained. Pendant alarms are issued to each resident, and an auditory alert is transmitted to kitchen on second floor and dining area on ground floor, identifying a number that is assigned to each resident. Facility employs awake night staff. An Emergency Disaster Plan is posted and location of utility shut offs is confirmed. Ground floor and second floor layouts are accurately reflected on facility sketch. There are no accessible bodies of water or fire safety hazards observed. Criminal record clearances or exemptions for facility staff or other individuals who have client contact are checked. Continued on following page.

NAME OF LICENSING PROGRAM MANAGER: April Cowan
NAME OF LICENSING PROGRAM ANALYST: Audrey Jeung
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: UPLYFT ASSISTED CARE LLC	FACILITY NUMBER: 385601231
	VISIT DATE: 06/30/2026

NARRATIVE

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The following items must be addressed before license is issued:

1. Hot water temperature tested at 128 degrees F and must be maintained between 105 and 120 degrees F (Section 87303 Maintenance and Operation)
2. Chairs are not present in each room so each resident has a chair in his/her room. (Section 87307 Personal Accommodations and Services)
3. Paints and building supplies are stored in unlocked storage shed in backyard. (Section 87309 Storage Space)
4. Seven day supply of canned non-perishable vegetables is not maintained. (Section 87555 Food Supply)
5. Facility sketch of third floor layout is not maintained. (Section 87208 Plan of Operation)
6. Rooms are not accurately identified by numbers as per facility sketch. Numbers are posted outside of bedrooms to identify occupants, not room numbers. (Section 87208 Plan of Operation)
7. Exit doors in two ground floor bedrooms are blocked. Clarification from fire inspector is needed to determine if these exits are required to be accessible, or if they can be obstructed.

Applicant to notify LPA upon completion of above items, and a follow up visit will be made.
Facility phone number is 415/571-8877.

NAME OF LICENSING PROGRAM MANAGER: April Cowan
NAME OF LICENSING PROGRAM ANALYST: Audrey Jeung
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026

LIC809 (FAS) - (06/04)

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