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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600401
Report Date: 09/29/2022
Date Signed: 09/29/2022 03:10:11 PM


Document Has Been Signed on 09/29/2022 03:10 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:BYXBEE HOMEFACILITY NUMBER:
385600401
ADMINISTRATOR:MARIA JASMIN NELSONFACILITY TYPE:
740
ADDRESS:383 BYXBEE STREETTELEPHONE:
(415) 586-4663
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:4CENSUS: 4DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Jasmin NelsonTIME COMPLETED:
10:55 AM
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On 9/29/2022, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was greeted by the administrator, Jasmin Nelson. LPA explained the purpose of the visit and LPA was screened at the front entrance.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident and staff daily monitoring records, containment strategies.

During the inspection, there are 2 residents present- 1 male and 1 female and the other 2 residents went to the day program. All the resident's rooms are private. PPE supply and the environmental cleaning supply are adequate, bathrooms are equipped with liquid soap and paper towels, and hand washing instruction is posted by the hand washing stations. Trash cans are observed to be foot operated. LPA observed COVID-19 signs posted through-out the facility. .

Medications, toxins and sharps are stored appropriately and inaccessible to resident, a comfortable temperature is maintained, lighting is sufficient for comfort and safety and food supply was checked and observed to be sufficient. First-aid kit is inspected and complete.

No deficiency cited today. This report is reviewed and discussed with the administrator. A copy is provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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