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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600417
Report Date: 02/02/2024
Date Signed: 02/05/2024 08:30:39 AM


Document Has Been Signed on 02/05/2024 08:30 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:QUALITY CARE HOMES, LLC 2FACILITY NUMBER:
385600417
ADMINISTRATOR:FAROL, FERNAND & VERANO, MFACILITY TYPE:
740
ADDRESS:757 - 44TH AVENUETELEPHONE:
(415) 747-2074
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:6CENSUS: 5DATE:
02/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Fernand FarolTIME COMPLETED:
02:30 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 02/02/2024, Licensing Program Analysts (LPAs) Grace Donato & John Calandra conducted a case management visit regarding and audit report that was requested last April 2022. LPA met with Administrator Fernand Farol. LPA explained the purpose of today's visit.

LPA discussed with the administrator the audit request that was done last April 2022. Administrator mentioned that he wasn't able to send the requested documents for this facility to the Audits Section.

Administrator mentioned that, currently, there is no issue finances.

Deficiencies are being cited today as the facility did not ensure that documents requested are submitted to the requesting auditor.

Deficiencies are cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties.

Report is reviewed and copy is provided together with appeals rights..
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
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 2


Document Has Been Signed on 02/05/2024 08:30 AM - It Cannot Be Edited

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: QUALITY CARE HOMES, LLC 2
FACILITY NUMBER: 385600417

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2024
Section Cited
CCR
87213

1
2
3
4
5
6
7
87213 Finances The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required...Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report ...
1
2
3
4
5
6
7
Licensee to submit requested documents to LPA by POC due date.
8
9
10
11
12
13
14
This was not met as evidenced by: Based on interview and records review, Licensee was not able to provide required documents to the auditor which poses an immediate health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type A
02/03/2024
Section Cited
CCR87405(b)(c)(d)(2)

1
2
3
4
5
6
7
87405 Administrator - Qualifications and Duties
(b)The administrator of a facility or facilities shall have the responsibility and authority... (c)Failure to comply with all licensing requirements pertaining to certified administrators...(d)The administrator shall have the qualifications...(2) Knowledge of and ability to conform to the applicable laws, rules and regulations.
1
2
3
4
5
6
7
Licensee to submit requested documents to LPA by POC due date.
8
9
10
11
12
13
14
This was not met as evidenced by based on records review Audits section wasn't able to confirm the organization generated sufficient income to meet its financial obligations which poses an immediate health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2