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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600595
Report Date: 10/25/2024
Date Signed: 10/25/2024 03:53:16 PM


Document Has Been Signed on 10/25/2024 03:53 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:ALHAMBRA HOME CAREFACILITY NUMBER:
415600595
ADMINISTRATOR:FEDERICO MIRANDAFACILITY TYPE:
740
ADDRESS:498 ALHAMBRA ROADTELEPHONE:
(650) 589-1900
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:6CENSUS: 6DATE:
10/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Judith Halili TIME COMPLETED:
04:00 PM
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On 10/25/2024, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Direct Support Professional, Judith Halili and LPA explained the purpose of the visit

LPA toured the facility inside and outside including all of resident rooms, garage, and kitchen area. LPA observed all residents resting in their bedrooms. Residents were observed to be arriving from the day program one by one. While touring the facility it was observed that the room temperature was at 68 deg F. Hot water was also tested in the bathrooms and the temperature was 112 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked. Food supply in kitchen and garage freezer and refrigerator was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill is done every quarter.

Six resident records and four staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated.

LPA received the following documents: LIC308, Control of Property, LIC500 & Liability Insurance
.
No deficiencies cited today. Report is reviewed and copy is provided.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024
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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