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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600802
Report Date: 04/05/2024
Date Signed: 04/05/2024 03:23:00 PM


Document Has Been Signed on 04/05/2024 03:23 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:PRECIOUS CARE HOMEFACILITY NUMBER:
415600802
ADMINISTRATOR:BONIFACIO, JOANNFACILITY TYPE:
740
ADDRESS:904 87TH STREETTELEPHONE:
(650) 992-2878
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:6CENSUS: 0DATE:
04/05/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:52 PM
MET WITH:Joann Bonifacio & Leona BonifacioTIME COMPLETED:
03:00 PM
NARRATIVE
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On 04/05/2024, Regional Manager (RM) Vivien Helbling, Licensing Program Analyst (LPA) Grace Donato and Licensing Program Manager (LPM) April Cowan met with Licensee, Joann Bonifacio & Leona Bonifacio to discuss facility closure.

The purpose of the meeting is to clarify the status of the following:

Facility closures of Precious Care Home and Holland House
Control of Property

Licensee to submit consent letter to licensing no later than COB on 4/5/2024. Licensee will close both facilities as Joann is no longer involved in facility operations and sold the business effective 6/30/2018, last day licensee operated was on 6/30/2018, Licensee sold both facilities as a business to Summit Capital that has been operating since 7/1/2018. Licensee lost control of property for Holland House on 6/30/18.

Deficiencies of the California Code of Regulations, Title, 22
cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties.

Report was reviewed and a copy is provided.

SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 04/05/2024 03:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: PRECIOUS CARE HOME
FACILITY NUMBER: 415600802

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2024
Section Cited
CCR
87211(h)

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87211 Reporting Requirements(h)Any change in the chief corporate officer of an organization, corporation or association shall be reported to the licensing agency in writing within fifteen (15) working days following such change. Such notification shall include the name, address, and the fingerprint card of the new chief executive officer, as required by Section 87355, Criminal Record Clearance.
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Licensee to submit consent letter to licensing no later than COB on 4/5/2024.
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This was not met as evidenced by LIcensee did not submit any notice from the facility regarding closure.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2