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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410508766
Report Date: 12/07/2022
Date Signed: 12/12/2022 01:31:48 PM

Document Has Been Signed on 12/12/2022 01:31 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 FACILITYFACILITY NUMBER:
410508766
ADMINISTRATOR:PALATTAO, RUBY M.FACILITY TYPE:
735
ADDRESS:45 RICE STREETTELEPHONE:
(650) 992-8076
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY: 5CENSUS: 0DATE:
12/07/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee/Administrator, Ruby PalattaoTIME COMPLETED:
03:30 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 December 12, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on a visit made on December 7, 2022 and deliver a copy of the amended report. LPA met with Licensee, Ruby Palattao and explained the purpose of the visit.

On December 7, 2022, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced collateral investigation visit. The Department received notification from the licensee, Ruby Palattao, that residents were relocated to 86 Rice Street in San Francisco, due to construction taking place at the licensed location at 45 Rice Street. LPA is meeting the licensee at 86 Rice Street for today's visit. LPA explained the purpose of today's visit.

With the licensee, LPA toured 86 rice street. Resident rooms are located on the ground floor. All resident bedrooms are fully equipped with required furniture. There are 5 residents relocated to 86 Rice Street during the construction. LPA observed the 4 male residents and 1 female resident. All are clothed, clean, and in place. LPA observed food supplies as in place as well as medications locked and in place in the kitchen. The move was made due to the county of San Mateo granting the facility funds to renovate the entire facility according to the licensee. Specifics of this grant are further discussed with LPA.

LPA discussed the Notice of Violation letter being handed to the licensee on December 7, 2022, and the importance of meeting the Department's requirements. The Licensee is currently operating unlicensed and is subject to civil penalties.

This is a violation under HSC §1508 and a citation is being issued on the following attached LIC809D.

LPA reviewed the report with the licensee and a copy is provided.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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 2
Document Has Been Signed on 12/12/2022 01:32 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/12/2022 12:42 PM


Created By: Komal Charitra On 12/07/2022 at 03:00 PM
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
SF COASTAL AC/SC, 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: 12/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/08/2022
Section Cited
HSC
1508

1
2
3
4
5
6
7
§§1508 Necessity of license; special permit; community care facility; local public agency defined..No person…within the state and no state or local public agency shall operate, establish, manage, conduct, or maintain a community care facility in this state, without a current valid license therefor as provided in this chapter...No person…within the state and no state or local public agency shall provide specialized services within a community care facility in this state, without a current valid special permit…
Each community care facility operated by a state or local public agency shall comply with the standards established by the director for community care facilities…
1
2
3
4
5
6
7
AMENDED**Licensee will communicate prior to any changes in operations/relocation, apply for relocation application and seek licensing approval.

8
9
10
11
12
13
14
AMENDED** This is a violation of Heath and Safety Code as evidenced by: Licensee, Ruby Palattao, informed the Department on 12/06/2022 of the relocation of residents to 86 Rice Street in San Francisco due to construction at Licensee's licensed home. The Licensee does not have a valid license to operate at this location. In addition, the Licensee did not seek Licensing’s approval prior to relocating the residents. Nevertheless, the Licensee is currently operating an unlicensed facility which poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Cara Smith
LICENSING EVALUATOR NAME:Komal Charitra
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2