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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410508866
Report Date: 08/13/2024
Date Signed: 08/13/2024 12:24:59 PM

Document Has Been Signed on 08/13/2024 12:24 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:CARE PLUS HOMEFACILITY NUMBER:
410508866
ADMINISTRATOR/
DIRECTOR:		ESTRELLA MANIOFACILITY TYPE:
735
ADDRESS:34 CAPAY CIRCLETELEPHONE:
(650) 225-9128
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 6CENSUS: 6DATE:
08/13/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Nenita BactadTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 8/13/2024 , Licensing Program Analyst(LPA) Grace Donato arrived at the facility to conduct a Plan of Correction(POC) visit with regards to citations given to the facility on 8/1/2024. LPA met with Care Staff Nenita Bactad and explained the purpose of the visit.

As of today, 8/13/2024, deficiencies have been cleared.

Report is reviewed and copy is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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