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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600789
Report Date: 04/04/2024
Date Signed: 04/04/2024 05:09:21 PM


Document Has Been Signed on 04/04/2024 05:09 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:TOYON CARE LLCFACILITY NUMBER:
415600789
ADMINISTRATOR:WEI, ANGELA Y.FACILITY TYPE:
740
ADDRESS:1000 TOYON DRIVETELEPHONE:
(415) 606-6829
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:6CENSUS: 6DATE:
04/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Caregiver, Val QuirosTIME COMPLETED:
11:30 AM
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On April 4, 2024 Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregivers, Val Quiros and Lai Chun Chan. LPA explained the purpose of the visit. Caregiver Val Quiros called and informed the administrator of today's inspection.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA toured inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort.

LPA observed 6 resident rooms (5 private and 1 shared rooms). Rooms were spacious and included all required furnishings. Bathrooms were observed to be clean; equipped with paper towels, soap, grab bars, and non-skid mats. Hot water temperature in the kitchen, and bathroom was measured at 108- 111 degrees F. 2 days for perishables and & 7 days non-perishable were observed to be present.

Facility is equipped with smoke detectors and carbon monoxide detectors. Fire drill records were reviewed.

LPA reviewed 3 resident records and 3 staff files.

The administrator certification expired and all the documents were sent for renewal in December 2023. LPA obtained a copy of the co-administrator certification, Solomon Li.

During today's inspection, there were 6 residents and 3 staff present.

No deficiency cited today.

This report is reviewed and discussed caregiver, Val Quiros. A copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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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