<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600266
Report Date: 09/25/2024
Date Signed: 09/25/2024 11:02:48 AM

Document Has Been Signed on 09/25/2024 11:02 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:ENCINA CARE HOMEFACILITY NUMBER:
415600266
ADMINISTRATOR/
DIRECTOR:		PERMITO, MARIA ELENAFACILITY TYPE:
740
ADDRESS:354 ENCINA AVENUETELEPHONE:
(650) 364-1657
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 6CENSUS: 5DATE:
09/25/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH: Consuelo Regoso, Caregiver and Maria Elena Permito, Administrator/LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On September 25, 2024, Licensing Program Analyst(LPA) John Calandra to complete the unannounced Annual 1-year required inspection started on September 6, 2024. LPA Calandra was greeted by Caregiver, Consuelo Regoso and explained the purpose of the visit. Administrator/Licensee, Maria Elena Permito arrived later during the visit.

LPA Calandra reviewed 2 resident files. Both 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(CSMR) kept at the facility.

LPA Calandra requested and received the following document during the visit:

-Administrator certificate which expires in 12/19/2025

No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Maria Elena Permito, Administrator/Licensee and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1