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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600421
Report Date: 02/06/2024
Date Signed: 02/06/2024 10:54:34 AM

Document Has Been Signed on 02/06/2024 10:54 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:CAYCO'S CARE HOMEFACILITY NUMBER:
385600421
ADMINISTRATOR:CAYCO, MARIBEL GFACILITY TYPE:
740
ADDRESS:1855 35TH AVENUETELEPHONE:
(415) 665-9409
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 6CENSUS: 4DATE:
02/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rodella Pasamonte and Jude Torres, CaregiversTIME COMPLETED:
11:15 AM
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On February 6, 2024, Licensing Program Analyst(LPA), John Calandra arrived at the facility at 9:52 AM to complete the Annual Inspection as FAS crashed and LPA Calandra lost his report and all other pages. LPA Calandra was greeted by Rodella Pasamonte, Caregiver at the door and explained to her the purpose of his visit. Jude Torres, Caregiver arrived later during the visit. Administrator, Maribel Cayco was unavailable as she was out of town when the LPA visited.

No deficiencies were cited during today's visit. A copy of the report and the POC clearance letter were sent and receipt confirmed by the Licensee/Administrator.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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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