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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410507207
Report Date: 11/18/2023
Date Signed: 11/18/2023 03:39:48 PM

Document Has Been Signed on 11/18/2023 03:39 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:P.A.R.C.A. CEDAR STREET HOUSEFACILITY NUMBER:
410507207
ADMINISTRATOR:DANIELLE SANCHEZFACILITY TYPE:
735
ADDRESS:721 CEDAR STREETTELEPHONE:
(650) 226-3798
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 8CENSUS: 5DATE:
11/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Counselor Julie WettsteinTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required visit. LPA met with Counselor Julie Wettstein, and the reason explained the reason for visit. Census:5

LPA Lund & Councilor Julie Wettstein toured/inspected the facility, including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. There are no bodies of water observed. Indoor and outdoor passageways are free of obstruction. A comfortable temperature for clients is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. All toilets, hand washing and bathing are safe, sanitary and in operating condition.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/23/2023. First aid kit was observed to be complete.

LPA reviewed 2 staff records and 2 of 2 staff have criminal record clearance or a criminal record exemption and holds a current first aid certificate. LPA reviewed 2 of 5 clients records.

No deficiencies during visit and report left.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2023
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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