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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600288
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:08:07 PM

Document Has Been Signed on 10/11/2023 03:08 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:ROSENER HOUSE ADULT DAY SERVICEFACILITY NUMBER:
415600288
ADMINISTRATOR:DAO DOFACILITY TYPE:
775
ADDRESS:500 ARBOR ROADTELEPHONE:
(650) 322-0126
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 80CENSUS: 51DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Program Director, Dao Do TIME COMPLETED:
03:20 PM
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On October 11, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual visit. LPA met with Program Director, Dao Do and explained the purpose of the visit.

During visit, there were 51 clients and 11 direct support professionals present.

LPA toured the facility and grounds, no accessible bodies of water or fire safety hazards observed. LPA toured the physical plant including but not limited to client restrooms, classrooms, activity area, art room, music room, kitchen, dining room, and outside area. Classrooms were observed to be clean and free from tripping hazards. LPA observed the mail classroom (great room) to be spacious. Residents were observed to be listening to music during the visit. LPA observed two private bathrooms and two separate communal bathrooms observed for women and men. Bathrooms were clean and equipped with liquid soap, paper-towels, and grab bars.

LPA toured the kitchen. Program Director stated kitchen door stays locked at all times. Sharps were observed to be stored appropriately and inaccessible to clients. According to the Program Director stated that clients' lunch are provided by Meals On Wheels program and brought to the facility in the morning. Staff warms the food in the kitchen area prior to serving lunch.

Medications were observed in a locked container in the nurse's room inaccessible to clients. Door to the nurse's room is in a locked area which is only accessible by staff. LPA observed fire extinguishers to be full and last serviced on 4/2023. First aid kit was observed to be present. Chemicals and toxins were observed to be in a locked shed in the outdoor area.

LPA reviewed 6 client files and 6 staff files. All staff are fingerprint cleared and associated to the facility. Files were observed to be complete.

No deficiencies are cited during the visit. Report is reviewed with Program Director and a copy is provided.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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