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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410507072
Report Date: 05/08/2024
Date Signed: 05/08/2024 11:01:01 AM

Document Has Been Signed on 05/08/2024 11:01 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:KAINOS TRIPLEX PLUSFACILITY NUMBER:
410507072
ADMINISTRATOR/
DIRECTOR:		FRISCH, ANDREWFACILITY TYPE:
735
ADDRESS:1209 CHANTEL WAYTELEPHONE:
(650) 364-5625
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 15CENSUS: 15DATE:
05/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Administrator - Andrew FrischTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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 05/08/2024, Licensing program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection. LPA met with Administrator Andrew Frisch and explained the purpose of today’s visit.

This is a two level facility that is 3 homes that are side by side and there is a fourth that's not connected that's adjacent to the parking lot. LPA Lund and administrator Andrew Frisch toured/inspected the facility. All outdoor and indoor passageway are free and clear of obstructions. Facility's ambient temperature is comfortable for residents and LPA. No pools or bodies of water were observed during today's visit on the premises. LPA observed fresh food supplies and emergency one week of nonperishable and two (2) days of perishable foods as in place. Each home has their own supplies in place. Toxic chemicals are stored away in a locked cabinets. Centrally stored medications are locked in a cabinet inside a staff room/office. Each room observed contained the required furniture as outlined in regulations . Facility has functioning smoke detectors in living room, hallway, and in each resident room. Carbon monoxide detectors are located in the hallways upstairs and downstairs and were tested. Fire extinguishers in the kitchen are full and were last inspected on 6/14/2023.

LPA reviewed 3 resident files and all are current. Facility does not handle resident monies at this location. LPA reviewed 5 staff files on this day and all are current with required documents and training. Administrator certificate is reviewed as expired as of 03/03/2024 but has submitted the appropriate renewal documents and is awaiting the new certificate at this time.

No deficiencies were cited during today's inspection and exit report given.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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 1