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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415201202
Report Date: 02/07/2025
Date Signed: 02/14/2025 02:40:10 PM

Document Has Been Signed on 02/14/2025 02:40 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/
DIRECTOR:
DELPHINE WILLIAMSFACILITY TYPE:
740
ADDRESS:1515 MADDUX DRIVETELEPHONE:
(650) 369-8383
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 6CENSUS: 4DATE:
02/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Delphine Williams, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:01 PM
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***************************************THIS IS AN AMENDED REPORT**************************************************

On 2/7/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Dionisio Rigor, Caregiver and explained the purpose of the visit. Delphine Williams, Administrator/Licensee arrived later during the visit.

LPA toured the physical plant. This is a 1-story building with 5 bedrooms (4 for residents and 1 for staff), 2 bathrooms, a dining room, kitchen, living room, front and backyards, etc. No accessible bodies of water or hazards were observed in hallways or the front or back yards. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. The facility's first aid kit was observed to have all required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's hot water was measured between the required 105-120 degrees Fahrenheit.

All sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care.

LPA reviewed 3 resident records and 3 staff files. All were observed to be complete.

A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility.

An exit interview was conducted. This report was reviewed with Mark Williams, Administrator and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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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Document Has Been Signed on 02/14/2025 02:40 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/12/2025 11:50 AM


Created By: John Calandra On 02/07/2025 at 11:23 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BRITANNIA PLACE

FACILITY NUMBER: 415201202

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Andrea Medlin
LICENSING EVALUATOR NAME:John Calandra
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2025


LIC809 (FAS) - (06/04)
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