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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600759
Report Date: 12/02/2022
Date Signed: 12/02/2022 01:39:28 PM


Document Has Been Signed on 12/02/2022 01:39 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:TLC HOME CORPORATIONFACILITY NUMBER:
415600759
ADMINISTRATOR:AGUILAR, ARACELIFACILITY TYPE:
740
ADDRESS:3090 MUIRFIELD CIRCLETELEPHONE:
(650) 360-3617
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:6CENSUS: 0DATE:
12/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Araceli AguilarTIME COMPLETED:
02:00 PM
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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management inspection visit to confirm the closure of this facility. LPA met with licensee Araceli Aguilar during today's inspection and explained the purpose of today's visit.

LPA toured the bedrooms of the residents. All three rooms are vacant. Furniture is in place in the rooms but there are no resident's or their personal belongings present. According to the licensee, all 4 residents were placed in other facilities as of October 30, 2022. The facility is vacant of residents and facility will be officially closed by December 6, 2022.

Report is reviewed with the licensee.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/02/2022
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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