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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600417
Report Date: 10/03/2024
Date Signed: 10/03/2024 11:15:38 AM

Document Has Been Signed on 10/03/2024 11:15 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/
DIRECTOR:
FAROL, FERNAND & VERANO, MFACILITY TYPE:
740
ADDRESS:757 - 44TH AVENUETELEPHONE:
(415) 747-2074
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 6CENSUS: 4DATE:
10/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:13 AM
MET WITH:Fernand Farol, Licensee & Staff, Rose CaspillionTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 10/3/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by staff, Rose Caspillion. Licensee, Fernand Farol was contacted and arrived later in the visit. The facility is a two story home that currently provides care for 4 residents, one of which is on hospice and none of which with dementia.

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 in thehallway and kitchen were observed and found to be charged. Smoke and carbon monoxide detectors were present and functioning. LPA requested for Licensee to change batteries in carbon monoxide detector. Technical Assistance.

There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished weekly and stored properly. Cleaning supplies and other toxins stored in the kitchen were fond to be secured. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items, with hospital bed orders on file. There is an backyard patio space for resident use, that is equipped with appropriate shading. During the inspection, residents were observed interacting with staff and one another in the common areas, or in their bedrooms resting. Residents appeared to have a positive relationship with the staff. Upon a spot check of medications, records and count were found to be in order. LPA reviewed resident records and found that residents (R1, R2) are in need of updating appraisals which are less than a month past annual updating. Technical Violation issued. In addition, upon review of staff records, Licensee is to update staff training and 1st aid & CPR certification that is expired less than a month prior to visit. Technical Violation issued.

Fernand Farol's Administrator Certification 7007993740 is currently active through 03/31/2025.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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