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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
410508766
Report Date:
04/19/2023
Date Signed:
04/19/2023 01:54:53 PM
Document Has Been Signed on
04/19/2023 01:54 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
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:
5
DATE:
04/19/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:30 PM
MET WITH:
Ruby Palattao
TIME COMPLETED:
02:00 PM
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit to confirm that residents are moved into this facility. LPA met with the licensee Ruby Palattao and explained the purpose of today's visit.
LPA observed that all five residents are fully moved in and now residing in the facility full times. Rooms are painted and furnished. Kitchen is complete just needing painting. All utilities are operating per observations and supplies are in place.
No citations issued.
Report is reviewed with licensee.
SUPERVISORS NAME
:
Cara Smith
LICENSING EVALUATOR NAME
:
Jaime Vado
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/19/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/19/2023
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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