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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600340
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:28:02 PM

Document Has Been Signed on 02/27/2025 12:28 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:RJ STARLIGHT HOME CORPORATIONFACILITY NUMBER:
385600340
ADMINISTRATOR/
DIRECTOR:
TERESITA JOMOKFACILITY TYPE:
740
ADDRESS:2680 BRYANT STREETTELEPHONE:
(415) 648-2280
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 12CENSUS: 10DATE:
02/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Lorna Gonzales, Teresita JomokTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On February 27, 2025, Licensing Program Analyst(LPA) Yi Sam Jian arrived at the facility at to conduct an unannounced Annual 1-year required inspection. LPA met with Lorna Gonzales, Caregiver. The Administrator, Teresita Jomok joined later during the visit.

LPA toured the physical plant. This is a story building that consists of 6 rooms and 3 bathrooms. Facility staff turned down the temperature of the water down in the presence of the LPA and inspected to be in compliant. Bathrooms were observed to have the required grab bars. Fire extinguishers in the facility were observed to be fully charged. No food was expired. The kitchen refrigerators and freezers temperature was within the required range. All bedrooms were sufficiently lit and had the required furniture. The backyard was clear from obstructions. No accessible bodies of water or hazards were observed. The facility's first aid was observed to be complete. The facility does not handle any cash resources. The facility was maintained at a comfortable temperature of 71 degrees Fahrenheit.

All knives and sharp objects were observed to be locked and in-accessible to persons in care. All medications, soaps, and detergents were observed to be locked and in-accessible to persons in care.

A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility.

No deficiencies were cited during today's visit. Technical Advisory Notes provided. The report was reviewed with administrator and a copy was left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Yi Sam Jian
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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