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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
415600133
Report Date:
01/23/2023
Date Signed:
01/23/2023 03:55:51 PM
Document Has Been Signed on
01/23/2023 03:55 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:
ATRIA PARK OF SAN MATEO
FACILITY NUMBER:
415600133
ADMINISTRATOR:
JENNIFER DUENAS
FACILITY TYPE:
740
ADDRESS:
2883 S NORFOLK ST
TELEPHONE:
(650) 378-3000
CITY:
SAN MATEO
STATE:
CA
ZIP CODE:
94403
CAPACITY:
175
CENSUS:
86
DATE:
01/23/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Shanel Thitphaneth and Kris Waluszko
TIME COMPLETED:
04:00 PM
NARRATIVE
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LPA Jeung met with resident
services director and regional vice president and inspected locking mechanism of doors in Life Guidance unit.
LPA inquired about personal toiletries in the possession of Life Guidance clients and advised that clients have the right to access these personal items unless their MD has specifically stated otherwise in writing. Mr. Waluszko advised that each shared suite--where a bathroom is shared but the bedroom is private--has a lockable cabinet in the bathroom.
No deficiency cited related to this case management visit.
SUPERVISOR'S NAME:
Cara Smith
TELEPHONE:
(650) 266-8800
LICENSING EVALUATOR NAME:
Audrey Jeung
TELEPHONE:
(650) 266-8891
LICENSING EVALUATOR SIGNATURE:
DATE:
01/23/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/23/2023
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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