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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600288
Report Date: 01/28/2025
Date Signed: 01/28/2025 01:02:10 PM

Document Has Been Signed on 01/28/2025 01:02 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ROSENER HOUSE ADULT DAY SERVICEFACILITY NUMBER:
415600288
ADMINISTRATOR/
DIRECTOR:
DAO DOFACILITY TYPE:
775
ADDRESS:500 ARBOR ROADTELEPHONE:
(650) 322-0126
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 80CENSUS: 50DATE:
01/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Program Director, Dao DoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On January 28, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit in relation to an incident that occurred on 1/15/25. LPA met with Program Director, Dao Do and explained the purpose of the visit.

On 1/16/25, the facility reported on 1/15/25 at 11:50am, Client 1 (R1) who is a new participant visiting the facility, eloped from the facility without staff knowing. According to staff, R1 was participating in the games activity from 11:15am-11:45am, however when all the clients moved to the lunch room, staff noticed R1 was not present. The Program Director, Program Manager, and Social Worker checked all rooms in the building and walked to the downtown area and located R1. All required parties were notified and all alarm systems have been checked twice.

During the visit, LPA requested a copy of R1's physician's report and file to review, however because R1 was not admitted to the day program, no documents were available for review. According to the Program Director, on 1/15/25, R1 was doing a trial day at the facility from 10am-12:30pm which is part of the facility's admission procedure. Program Director indicated that the facility does an initial screening that includes an intake form and a formal tour. The family then schedules a trial day where the client comes to the program for a few hours, and after the trial day, if client is acceptable, the facility requests completed documents to be submitted prior to client attending the program as a formal client.

Program Director provided in-service training to staff regarding procedures for missing persons and a copy was provided to LPA with an attendance sheet. LPA toured and tested the 5 delayed-egress exit doors around the facility. All delayed-egress door were observed to be functioning.

No citations are issued during the visit. Report is reviewed with Program Director and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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