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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415201202
Report Date: 09/19/2024
Date Signed: 09/19/2024 03:20:36 PM


Document Has Been Signed on 09/19/2024 03:20 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:BRITANNIA PLACEFACILITY NUMBER:
415201202
ADMINISTRATOR:DELPHINE WILLIAMSFACILITY TYPE:
740
ADDRESS:1515 MADDUX DRIVETELEPHONE:
(650) 369-8383
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:6CENSUS: 4DATE:
09/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Delfine Williams, Licensee/Administrator and Mark Williams, AdministratorTIME COMPLETED:
03:30 PM
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On September 19, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to an incident that occurred on September 4, 2024 in which a client was able to leave the facility unassisted. LPA Calandra was greeted by Licensee/Administrator, Delfine Williams and explained the purpose of the visit. Mark Williams, Administrator arrived later during the visit.

LPA Calandra requested the following documents:

-Current resident files
-LIC 602 for resident
-Needs and Services Plan for resident
-Updated LIC 500

During the visit, LPA Calandra observed 1 resident in the living room watching tv, 2 residents sleeping in their bedrooms, and 1 resident in their bedroom sitting in their chair visiting with their relative.

Based on LPA's review of documents including LIC 602-Physician's reports for all current residents and R1, Needs and Services plan for R1, facility's program description, interview with staff, etc., it was determined that the facility did not violate Title 22 or the Health and Safety code.

No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Mark Williams, Administrator and Delfine Williams, Administrator/Licensee and a copy of the report left at the facility.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024
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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