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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600003
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:19:44 PM

Document Has Been Signed on 12/19/2023 04:19 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:PROGRESS FOUNDATION - ASHBURY HOUSEFACILITY NUMBER:
385600003
ADMINISTRATOR:SARAH PETERSFACILITY TYPE:
772
ADDRESS:212 ASHBURY STREETTELEPHONE:
(415) 775-6194
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 20CENSUS: 3DATE:
12/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Raegan Riley, Fernando Portillo QuintanTIME COMPLETED:
10:30 AM
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On 12/19/2023, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced case management visit to follow up on the facility's total capacity. LPA met with Program Director Raegan Riley & Counselor Fernando Portillo Quintan and explained the purpose of the visit.

LPA toured the facility and it was observed to have 3 floors with a total of 10 bedrooms, with three residents living here. Counselor Fernando & PD Raegan Riley explained that facility can accept up to ten residents/mothers and the rest of the capacity will be the kids. Capacity is being adjusted depending on the number of kids the mother has. Age limit for kids is 13 and below.

No deficiency cited today.

Report is reviewed and copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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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