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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600191
Report Date: 04/21/2022
Date Signed: 04/21/2022 11:44:17 AM


Document Has Been Signed on 04/21/2022 11:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:ATRIA DALY CITYFACILITY NUMBER:
415600191
ADMINISTRATOR:AMANDA NORTHFACILITY TYPE:
740
ADDRESS:501 KING DRTELEPHONE:
(650) 878-5111
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:120CENSUS: 61DATE:
04/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Interim Executive Director, Amanda NorthTIME COMPLETED:
12:15 PM
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On April 21, 2022, Licensing Program Analysts (LPA) Komal Charitra conducted an unannounced plan of correction (POC) visit to verify and to confirm that the facility is in compliance with the citations that were issued on 4/8/2022. LPA Charitra met with Interim Executive Director, Amanda North, and explained the purpose of the visit.

On 4/8/2022, the facility was cited for California Code of Regulation (CCR) 87205(a-b) Accountability of Licensee Governing Body which is a type A violation. In addition, CCR, 87206(a) Advertisement and License Number, 87109(b) Transferability of License, 87211(a)(1) Reporting Requirements, and 87411(a) Personnel Requirements were cited.

The plan of correction for citation 87205(a-b) Accountability of Licensee Governing Body was due to CCLD by 4/9/2022 and the other four citations were due to CCLD by 4/15/2022.

On 4/21/22, LPA Charitra reviewed and verified the plan of correction documents provided by the facility for citation, 87411(a) Personnel Requirements and 87211(a)(1) Reporting Requirements. In addition, the facility was able to provide LPA a plan of correction for citation, 87206(a) Advertisement and License Number.

Due to the citation 87205(a-b) Accountability of Licensee Governing Body,not being corrected by 4/9/2022, a civil penalty is being assessed in the amount of $100 a day from 4/10/2022 through 4/21/2022 and will continue to accrue until corrected.

In addition, due to citation, 87109(b) Transferability of License, not being corrected by 4/15/2022, a civil penalty is being assessed in the amount of $100 a day from 4/16/2022 through 4/21/2022 and will continue to accrue until corrected.

Report is reviewed with Interim Executive Director, Amanda North, and a copy if provided with the appeal rights.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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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