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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600419
Report Date: 04/19/2022
Date Signed: 04/19/2022 10:28:52 AM


Document Has Been Signed on 04/19/2022 10:28 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:QUALITY CARE HOMES, LLC 4FACILITY NUMBER:
385600419
ADMINISTRATOR:FAROL, FERNANDFACILITY TYPE:
740
ADDRESS:475 EUCALYPTUS DRIVETELEPHONE:
(415) 564-6318
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:10CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Caregiver, Rosalinda SubidaTIME COMPLETED:
10:40 AM
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On 4/19/2022, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit regarding the facility closure. LPA rang the door bell and met with caregiver, Rosalinda Subida. LPA explained the purpose of the visit and Ms. Subida notified the administrator by phone of LPA's visit.

LPA toured the facility and verified that there are no residents who requires care and supervision. The resident's rooms, beds, drawers and closets were empty.

CCLD will be proceeding with the closure. A forfeiture letter will be sent to the administrator and the facility number 385600419 shall be closed.

This report is reviewed and discussed with the caregiver.

A copy is provided.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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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