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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410508815
Report Date: 09/05/2024
Date Signed: 09/05/2024 02:04:32 PM

Document Has Been Signed on 09/05/2024 02:04 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:FHAR - SNEATH LANE HOMEFACILITY NUMBER:
410508815
ADMINISTRATOR/
DIRECTOR:		SURDEL, PHILFACILITY TYPE:
735
ADDRESS:3600 SNEATH LANETELEPHONE:
(650) 589-6152
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 6CENSUS: 6DATE:
09/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
MET WITH:Administrator - Phil SurdelTIME VISIT/
INSPECTION COMPLETED:
NARRATIVE
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On 09/05/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - other visit in order to deliver an exclusion letter regarding a staff person. LPA explained the purpose of today's visit with the administrator Phil Surdel.

LPA provided the letter to the Phil and discussed the reason of the letter. Per Phil the staff person has not been working at the facility since the incident took place on 08/14/2024.

Phil understands the purpose of the letter and will follow its instructions.

Report is reviewed with Phil and a copy is provided on this day.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE: DATE:
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE:
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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