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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410507269
Report Date: 02/10/2025
Date Signed: 02/10/2025 12:46:37 PM

Document Has Been Signed on 02/10/2025 12:46 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:CASSIA HOUSEFACILITY NUMBER:
410507269
ADMINISTRATOR/
DIRECTOR:
MARY BETH SANDOVALFACILITY TYPE:
735
ADDRESS:420 CASSIA STREETTELEPHONE:
(650) 363-8125
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 14CENSUS: 14DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Administrator, Mary Beth SandovalTIME VISIT/
INSPECTION COMPLETED:
12:56 PM
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On February 10, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual visit. LPA met with Administrator, Mary Beth Sandoval and explained the purpose of the visit.

LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a two story facility. There are seven shared client bedrooms, four common bathrooms, dining room, kitchen, common recreational room, laundry room, storage areas and offices. Client rooms were observed with all required furniture. Bathrooms were clean and odor-free and in good repair. Water temperature throughout the facility measured between 111-116 degrees F. Extra linen was observed to be present. First aid kit was observed to be complete.

Dining room was observed free from tripping hazards with snacks. A comfortable temperature of 70 degrees is maintained and lighting is sufficient for comfort. LPA observed two day perishables and seven day non-perishables. Extra food supply was observed to be present. Medications, sharps, and chemicals were observed locked an inaccessible to clients in care. LPA observed an administrative office and one counselors office on the first floor.

Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of July 2024. Emergency drills are logged and done every month. LPA reviewed 5 client records and 5 staff records. Client records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated.

No citations are issued during this visit. Report is reviewed with the Administrator, Mary Beth Sandoval and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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