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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410508557
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:08:25 PM

Document Has Been Signed on 11/15/2024 03:08 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:FARM HILL REST HOMEFACILITY NUMBER:
410508557
ADMINISTRATOR/
DIRECTOR:		RYAN, EVELYN B.FACILITY TYPE:
740
ADDRESS:3646 FARM HILL BLVD.TELEPHONE:
(650) 366-6535
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 6CENSUS: 2DATE:
11/15/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Elenita "Ruby" Cruz, Caretaker and Corazon Medina, Lead Staff, Evelyn Ryan, Administrator/LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On November 15, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:30 PM to complete the Annual 1-year required inspection. LPA Calandra was greeted by Elenita "Ruby" Cruz, Caretaker and explained the purpose of the visit. Evelyn Ryan, RN, Licensee/Administrator and Corazon Medina, Lead Staff arrived later during the visit.

LPA Calandra reviewed 2 resident files. Both were observed to be complete.

LPA interviewed 1 staff and 1 resident.

No deficiencies were cited during today's visit.

This report was reviewed with Evelyn Ryan, RN, Licensee/Administrator and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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