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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410508749
Report Date: 04/04/2024
Date Signed: 04/04/2024 04:29:30 PM

Document Has Been Signed on 04/04/2024 04:29 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:CARING HEARTS HOME #2FACILITY NUMBER:
410508749
ADMINISTRATOR/
DIRECTOR:		NINA ALIASONFACILITY TYPE:
735
ADDRESS:744 SKYLINE DRIVETELEPHONE:
(650) 878-5964
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 6CENSUS: 6DATE:
04/04/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:32 PM
MET WITH:Elvira Cano, Direct Support Professional TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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 April 4, 2024 at 3:30 PM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the Annual Inspection. LPA Calandra was greeted at the door by Elvira Cano, Direct Support Professional(DSP) and explained the purpose of his visit. LPA Calandra called Administrator, Nina Aliason and left a voicemail explaining the purpose of his visit. Nina Aliason, Administrator called back and spoke with LPA Calandra but was unable to join the visit.

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

LPA Calandra interviewed 1 staff member and 2 residents.

No deficiencies were cited during today's visit.

This report was reviewed with Elvira Cano, DSP and a copy of the report left at the facility.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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