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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600396
Report Date: 02/21/2024
Date Signed: 02/21/2024 04:40:05 PM


Document Has Been Signed on 02/21/2024 04:40 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:
02/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Katie Eiseman, Administrator/Licensee, Geselle Grey, Team TIME COMPLETED:
04:45 PM
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On February 21, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 3:00 PM to conduct the Annual 1-year required visit. LPA Calandra was greeted by Massiel Perez, Team member and explained the purpose of his visit. Katie Eiseman, Administrator/Licensee and Geselle Grey, Lead Caregiver arrived later during the visit.

LPA Calandra toured the physical plant. This is a two story building that consists of 7 bedrooms and 4 bathrooms, a dining room, kitchen, living room, and sun room. Water in all bathrooms was measured between the required 105-120 degrees Fahrenheit. Bathrooms were observed to have the required grab bars and anti-skid mats. Fire extinguishers in the facility were observed to be fully charged and last inspected on February 22, 2023. The facility had the required 7 days of non-perishables and 2 days of perishables on site. No food was expired. The kitchen refrigerators and freezers temperature were 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 does not handle cash resources at this time. The facility was maintained at a comfortable temperature of 72 degrees Fahrenheit.

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

LPA Calandra reviewed 2 resident files. All were observed to be complete.

LPA Calandra requested the facility send the following documents to the department:

-Liability Insurance
-Health Screening Reports
-Administrator Certificate
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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: 02/21/2024
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No deficiencies were cited during today's visit.

The Annual will be continued at a later date.

This report was reviewed with Administrator/Licensee, Katie Eiseman and Geselle Grey, Lead Caregiver and a copy left at the facility.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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