<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600396
Report Date: 03/06/2024
Date Signed: 03/06/2024 01:59:20 PM

Document Has Been Signed on 03/06/2024 01:59 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:SUNSET GARDENSFACILITY NUMBER:
385600396
ADMINISTRATOR:EISEMAN, KATIEFACILITY TYPE:
740
ADDRESS:1338 27TH AVENUETELEPHONE:
(650) 219-9645
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 13CENSUS: 9DATE:
03/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Katie Eiseman, Administrator/LicenseeTIME COMPLETED:
02:15 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
On March 6, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:00 AM to complete the Annual 1-year required inspection started on February 21, 2024. LPA Calandra was greeted by Massiel Perez-Jiron and Elizabeth Celso, Team Members. Lead Caregiver, Geselle Grey, and Administrator/Licensee, Katie Eiseman arrived later during the inspection.

LPA Calandra reviewed 5 resident and 5 staff files. All were observed to be complete.

LPA Calandra interviewed 3 clients and 2 staff.

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.

The report was reviewed with Katie Eiseman, Administrator/Licensee, and a copy of the report left at the facility.


SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1