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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410508766
Report Date: 10/30/2025
Date Signed: 10/30/2025 01:45:48 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/30/2025 01:45 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:RICE RESIDENTIAL CARE FACILITYFACILITY NUMBER:
410508766
ADMINISTRATOR/
DIRECTOR:		PALATTAO, RUBY M.FACILITY TYPE:
735
ADDRESS:45 RICE STREETTELEPHONE:
(650) 992-8076
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY: 5CENSUS: 5DATE:
10/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Administrator - Ruby PalattaoTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 10/27/2025, Licensing Program Analyst (LPA) Vado Jaime Vado conducted an unannounced annual required inspection visit. LPA Vado met with staff person Arisval Palattao. There are 5 clients present on this day and 1 live in staff. During today's inspection the licensee, Ruby Palattao and her husband arrived around 10:30am.

This is a two level facility licensed for residents age range 18 - 59 years. All must be ambulatory. This is a two level facility.The physical plant was toured inside and outside of the facility to ensure the safety of the residents. There is only one operable camera in the facility that is positioned in the living room. There are no other cameras that are functioning at this two. LPA observed two additional camera that are hard wired but was informed that they do no work. The upper floor is where the clients reside in three rooms, and the lower level is where the staff reside according to Ruby. Facility temperature is comfortable for clients and staff present. There is one staff room on the ground floor and a living room. The door to the backyard is accessible via the living room. The backyard is observed to have 3 clothes lines and on one clothes line LPA was informed a clients clothing is on the line for drying. The laundry area is located in the garage and both washer and dryer is functioning per Ruby and Arisval when asked. The garage is locked to clients. Cleaning supplies are locked in the garage area. LPA observed the facility kitchen. The appliances in place are observed to be operational. The kitchen sink has multiple unwashed dishes that is washed during today's visit. On the top of the cooking range, there are multiple pots and pans are observed to be unwashed as well. This poses a potential health and safety risk to clients. The refrigerator is observed to have food items for clients in place. Canned and emergency food supplies are observed to be in place. Emergency dried food bucket is observed in the living room as well.

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NAME OF LICENSING PROGRAM MANAGER: April Cowan
NAME OF LICENSING PROGRAM ANALYST: Jaime Vado
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: RICE RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 410508766
VISIT DATE: 10/30/2025
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First aid kits are observed as complete with required items. This is housed in the kitchen in a cabinet adjacent to the sink. Medications are observed to be locked in a cabinet area in the kitchen. LPA observed at least one fire extinguisher in place which is currently within operating range with an inspection date of 01/15/2025, smoke detector, carbon monoxide detectors are observed in place. There is a fire pull station observed near the front door by the kitchen. Emergency exit routes are observed inside and outside with the main exit being the front door out to the main street. Water temperature is measured at 116F in the client bathroom on the upper floor. The bathroom is observed to need cleaning. There is a urine smell and mold is observed on the shower walls, window, and ceiling. Around the bottom of the toilet is dirt or grime which may be causing the odor. This poses a potential health and safety risk to clients in care. LPA observed all client rooms on the upper floor. Client rooms contain the required items outlined in regulation. Resident linen supplies are observed as in place. There is a non-skd mat in the shower that is clean and in place. Client bathroom uses a hand dryer instead of paper towels for client use. LPA observed that the furniture in the living room has ripped upholstery. A single couch and a love seat have ripped upholstery and the bottom of the love seat appears to be broken and sinking in.

Client and staff iles are reviewed today and both are observed to be current. Client medications are reviewed as well today and all medications are in place and accurate. Facility only handles the monies of one resident and it is observed to be currently recorded and in place. Per record observed, last emergency drill was conducted on 09/05/2025

Citations issued on the following LIC809D page.


Report is reviewed with administrator Ruby Palattao and a copy is provided on this day.
NAME OF LICENSING PROGRAM MANAGER: April Cowan
NAME OF LICENSING PROGRAM ANALYST: Jaime Vado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/30/2025 01:45 PM - It Cannot Be Edited


Created By: Jaime Vado On 10/30/2025 at 11:43 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: RICE RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 410508766

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2025
Section Cited
CCR
80087(a)

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80087(a) Buildings and Grounds -The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This regulation has not been met as evidenced by:
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Facility shell develop a written plan to address how the facility will abide by this regulation at all times. Written plan shall be received by the due date assigned.
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Based on observations made, LPA observed a urine smell in the client bathroom and mold is observed on the shower walls, window, and ceiling. Around the bottom of the toilet is dirt or grime which may be causing the odor. Also observed is the kitchen sink has multiple unwashed dishes that was washed during today's visit. On the top of the cooking range, there are multiple pots and pans are observed to be unwashed as well. Also observed is that the furniture in the living room has ripped upholstery. A single couch and a love seat have ripped upholstery and the bottom of the love seat appears to be broken and sinking in. These pose a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
April Cowan
NAME OF LICENSING PROGRAM MANAGER:
Jaime Vado
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2025


LIC809 (FAS) - (06/04)
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