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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600398
Report Date: 11/12/2023
Date Signed: 11/13/2023 07:20:46 AM


Document Has Been Signed on 11/13/2023 07:20 AM - 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 CARE HOME 2FACILITY NUMBER:
385600398
ADMINISTRATOR:ZHANG, ALICE FENGFACILITY TYPE:
740
ADDRESS:1367 39TH AVENUETELEPHONE:
(415) 516-9368
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:6CENSUS: 0DATE:
11/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Alice Feng ZhangTIME COMPLETED:
03:00 PM
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On 11/12/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA met with Facility Designated Administrator, Alice Feng Zhang and explained the purpose of the visit.

This facility is licensed to serve 6 residents who are 60 or older, of which 6 out 6 residents may be non-ambulatory.

This facility currently does not have residents in care. FDA Zhang expressed that she was unsure if she will obtain residents at this time. LPA Pascua informed FDA Zhang of the closure procedures.
No records were reviewed during the course of this visit.

A tour of the facility was conducted.
A tour of 4 resident bedrooms were conducted. Furniture and furnishings were observed to be stable and in good repair.
A tour of 3 bathrooms were conducted, hot water was measured to ensure Title 22 compliance.
Kitchen area was toured.
A tour of the backyard was conducted with no hazards present.
Facility is equipped with smoke detectors and carbon monoxide detectors. LPA also observed the fire extinguishers which were purchased on 11/12/2023.
The annual fees are current for this facility, and the Administrator will notify CCL of any changes.

Based on the observations made during this visit no deficiencies were observed or cited during this annual visit. An exit interview was conducted and a copy of this report was given to Facility Designated Administrator.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 11/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2023
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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