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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600197
Report Date: 08/30/2024
Date Signed: 08/30/2024 09:25:51 AM


Document Has Been Signed on 08/30/2024 09:25 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:FRIENDLY ACRES ELDERLY HOMEFACILITY NUMBER:
415600197
ADMINISTRATOR:FRANCO, KALAITA TAVAKEFACILITY TYPE:
740
ADDRESS:3526 PAGE STREETTELEPHONE:
(650) 369-4503
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:6CENSUS: 3DATE:
08/30/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Kalaita Franco & Michael AlvisTIME COMPLETED:
09:45 AM
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On August 30, 2024 Licensing Program Analysts(LPAs) Grace Donato and Kiran Jain arrived at the facility to conduct a Plan of Correction(POC) visit with regards to citations given to the facility on 8/22/2024. LPAs met with Kalaita Franco, Administrator & Michael Alvis, cargiver and explained the purpose of the visit.

As of today, 8/30/2024, deficiencies have been cleared.

Report is reviewed and copy is provided.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Kiran JainTELEPHONE: 650-416-4836
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
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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