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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
410508766
Report Date:
11/04/2022
Date Signed:
09/05/2023 09:44:29 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
09/05/2023 09:44 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
SF COASTAL AC/SC
,
851 TRAEGER AVE., SUITE 360
SAN BRUNO
,
CA
94066
FACILITY NAME:
RICE RESIDENTIAL CARE FACILITY
FACILITY NUMBER:
410508766
ADMINISTRATOR:
PALATTAO, RUBY M.
FACILITY TYPE:
735
ADDRESS:
45 RICE STREET
TELEPHONE:
(650) 992-8076
CITY:
DALY CITY
STATE:
CA
ZIP CODE:
94014
CAPACITY:
5
CENSUS:
0
DATE:
11/04/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:15 PM
MET WITH:
N/A
TIME COMPLETED:
02:45 PM
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On this day Licensing Program Analyst (LPA) Jaime Vado attempted to conduct a COVID health and safety annual inspection.
LPA rang the door bell and knocked on the door. LPA could not hear any noises from within the facility. Adjacent to the main stairs up to the facility is a window. Curtains were open but no one can be seen or heard.
LPA will re attempt this annual at another time.
SUPERVISORS NAME
:
Cara Smith
LICENSING EVALUATOR NAME
:
Jaime Vado
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/04/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/04/2022
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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