385600396-2-19-2025-14-AS-DTOA-DE2RLZ-20250219120759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 385600396
Report Date: 02/19/2025
Date Signed: 02/19/2025 12:08:14 PM

Document Has Been Signed on 02/19/2025 12:08 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 GARDENS		FACILITY NUMBER:	385600396
ADMINISTRATOR/ DIRECTOR:	EISEMAN, KATIE		FACILITY TYPE:	740
ADDRESS:	1338 27TH AVENUE		TELEPHONE:	(650) 219-9645
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY: 13	TOTAL ENROLLED CHILDREN: 0	CENSUS: 11	DATE:	02/19/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Katie Eisman, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:15 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 2/19/2025, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver, Elizabeth Celso. Administrator, Katie Eiseman was contacted and arrived later in the visit. The facility currently provides care for 11 residents, 4 of which are receiving hospice services. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each resident floor and kitchen, garage and laundry room were found to be charged. Carbon monoxide detectors were located at each hallway tested and functioning. Smoke and sprinkler systems are interconnected with a fire safety inspection conducted by separate outside agency. All resident restrooms are equipped with non-slip mats and grab bars for accessibility. All auditory alarms were in working order with alarms signaling to the front entrance. During the inspection, LPA observed garage door pin-pad lock in need of repair as it was not locking consistently. Upon inspection, LPA did not observe any items that could pose as a risk. For preventative measures, Administrator agrees to fix pin-pad lock immediately. Technical assistance issued. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen and garage, sufficient for residents in care. Food supply is replenished weekly and stored properly. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets in the laundry room, all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Continued onto LIC809-C

Andrea Medlin	TELEPHONE: (650) 266-8811
Dominic Tobola	TELEPHONE: (650) 393-9128
	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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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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: SUNSET GARDENS	FACILITY NUMBER: 385600396
	VISIT DATE: 02/19/2025

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Residents that were awake during the inspection were observed interacting with staff, fellow residents and visitors in the common areas, or in their bedrooms resting. The facility encourages regular family visits and utilizes a wide variety of activities with LPA observing staff and resident engaging in activities including exercise, group reading and bible study during the inspection. Residents were observed to have a positive and personable relationship with staff. There is a large outdoor patio for resident use, equipped with appropriate shading.

A spot check of medications was conducted and found that all medication counts and records are in order. LPA conducted a sample file review for residents and found all items to be in order including medical assessments and needs & service plans. Upon a spot check of staff files, LPA found that caregiver staff have annual training and current 1st aid and CPR on file.

Katie Eiseman's Administrator Certificate 6024255740 is currently active through 1/18/2025 and has submitted updated items for re-certification.

LPA requested the following documents be sent to CCL by COB 3/5/2024:

LIC 308 Designated Facility Responsibility
LIC 500 Personnel Summary
LIC 610 Emergency Disaster Plan
Liability Insurance

No deficiencies cited during today's visit.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC809 (FAS) - (06/04)

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