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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410508648
Report Date: 12/12/2024
Date Signed: 12/12/2024 11:08:32 AM

Document Has Been Signed on 12/12/2024 11:08 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:BRITANNIA HOUSEFACILITY NUMBER:
410508648
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, DELPHINEFACILITY TYPE:
740
ADDRESS:1608 ALAMEDA DE LAS PULGASTELEPHONE:
(650) 361-8383
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 6CENSUS: 5DATE:
12/12/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Delphine Williams, Licensee and Mark Williams, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On December 12, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:00 AM to complete the Annual 1-year required inspection. LPA Calandra was greeted by Miriam Menor, Caregiver and explained the purpose of the visit. Mark Williams, Administrator arrived later during the visit.

A review of Centrally Stored Medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility.

LPA Calandra received the following document at the facility:
  • Certificate of Liability Insurance

The following document was requested to be sent to the Department by 12/19/2024:
  • Updated LIC 500

No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Mark Williams, Administrator and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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