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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600417
Report Date: 10/14/2026
Date Signed: 10/14/2026 01:21:35 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/14/2026 01:21 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: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: 6DATE:
10/14/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Caregiver - Gabriele AlfonsoTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 10/14/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced an Annual Required – 1 yr. inspection. LPA met with staff person Gabriele Alsonso and explained the purpose of today's visit. Licensee/administrator, Fernand Farol is not present. During today's visit, there are 6 residents in care and 2 staff persons.

This facility is licensed for ages 60 and over. All may be non-ambulatory. Hospice waiver for 3 residents. Currently there is only 1 resident on hospice. This is a single level facility, with a lower garage area accessible via a door in the kitchen. LPA toured the facility inside and out. LPA made observations of the living room, dining area, kitchen, bedrooms, bathrooms, backyard, and emergency egress routes. Indoor and outdoor passageways are free of obstruction. The facility consists of 5 resident rooms and 2 full bathrooms. Water in the bathrooms at 118F. Bathrooms were observed to have the required grab bars, non-skid mats and in good operating condition. Beneath the sink of the larger bathroom is a locked area where cleaning supplies are observed. Linens are observed as in place in a closet in the main hallway. Facility furniture and furnishings are observed to be in place and in good condition. Food supplies are sufficient. 2 day perishables and 7 day non-perishables supplies are in place. Facility ambient temperature is warm and comfortable for residents, staff, and visitors. Lighting is sufficient for through out for safety and visibility. Resident bed sheets, linens, and towels are observed to be in place. No odors present. Medication storage and sharps are observed to be secured.

Continued on next page...
April Cowan
Jaime Vado
DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: QUALITY CARE HOMES, LLC 2
FACILITY NUMBER: 385600417
VISIT DATE: 10/14/2026
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LPA observed at least 3 fire extinguishers in place with inspection tags dated 02/02/2024. Facility has a fire alarm panel located in the linen closet. Smoke detectors are hardwired. There is a fire pull station located in the main hallway where resident rooms are located. Carbon monoxide detector is observed as in place in dining room above dining table. Required postings are observed. Administrator certificate is observed as expired Fernand Farol on 03/31/2021 per posting on facility wall. Per facility licensee, an appointed administrator has been designated named Maria Gonzales who holds a curret administrator certificate.

LPA reviewed 6 resident record and 3 staff files are reviewed. Las fire drill was conducted on 09/04/2026 according to record reviewed. Records reviewed are not current.

Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the following LIC809D. Failure to correct the deficiencies may result in civil penalties.

This report is reviewed and discussed with staff. A copy of this report and the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: April Cowan
NAME OF LICENSING PROGRAM ANALYST: Jaime Vado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/14/2026 01:21 PM - It Cannot Be Edited


Created By: Jaime Vado On 10/14/2026 at 12:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 10/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2026
Section Cited
CCR
87463(a)

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87463(a) Reappraisals - The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.This regulation has not been met as evidenced by:
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Facility shall develop a written plan showing how it will meet this regulation at all times. Written plan shall be submitted by the due date shown.
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Based on resident records reviewed, only 2 of 4 residents have LIC625 on file. LIC625 is considered as part of the reappraisal, and all apprasails are to be trasferred to the LIC625.
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Type B
10/20/2026
Section Cited
CCR87411(c)(1)

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87411(c)(1) Personnel Requirements - Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement has not been met as evidenced by:
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Facility shall develop a written plan showing how it will meet this regulation at all times. Written plan shall be submitted by the due date shown.
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Based off of staff records review, a staff person did not have a current first aid card on file expiring on 10/03/2026.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
April Cowan
NAME OF LICENSING PROGRAM MANAGER:
Jaime Vado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/14/2026 01:21 PM - It Cannot Be Edited


Created By: Jaime Vado On 10/14/2026 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 10/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2026
Section Cited
CCR
87506(a)

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87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement has not been as evidenced by:
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Facility shall develop a written plan showing how it will meet this regulation at all times. Written plan shall be submitted by the due date shown and update all resident files.
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Based on resdient records reviewed, 2 of 4 resident records reviewed did not have needs and services plan. 1 of 4 did not have a physician's report on file.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
April Cowan
NAME OF LICENSING PROGRAM MANAGER:
Jaime Vado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2026


LIC809 (FAS) - (06/04)
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