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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600808
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:17:10 PM

Document Has Been Signed on 09/04/2024 12:17 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:ALWAYS TLCFACILITY NUMBER:
415600808
ADMINISTRATOR/
DIRECTOR:		CONSUNJI, TOMASFACILITY TYPE:
740
ADDRESS:226 SANDPIPER COURTTELEPHONE:
(650) 345-1441
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 6CENSUS: 6DATE:
09/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Caregiver, Doris MoresTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On September 4, 2024, Licensing Program Analyst (LPA) Murial Han and Komal Charitra conducted an unannounced plan of correction visit to follow up on a civil penalty that was assessed on 8/20/2024. LPA met with caregiver, Doris Mores and explained the purpose of the visit. The administrator arrived shortly thereafter and assisted with the visit.

On 8/ 20/2024, LPA Han conducted an unannounced Plan of Correction visit to follow up on the citations that were issued during the annual inspection on 8/6/ 2024. During the visit, LPA reviewed and validated the plan of correction that was submitted by the administrator/licensee and cleared 9 out of 12 citations However, LPA observed the remaining citations- 1569.695(c); 87608(a)(5)(B); 1569.625(b)(2) were not corrected and due to the citations not being corrected, a civil penalty in the amount of $3300 was assessed from 8/8/2024 - 8/20/2024.

During today's visit, LPAs reviewed the plan of correction for the following citations:

- 1569.695(c)- Emergency drill was conducted on 8/23/2024 and the administrator stated that it will be conducted on a quarterly basis.

- 87608(a)(5)(B)- Physician orders were obtained for the residents who have a bed rail by the head of the bed.

- 1569.625(b)(2)- Annual training was started for staff on 8/30/2024 and will continue.

Civil penalty is being stopped on 8/21/2024 as the above citations are observed to be corrected.

No deficiency is cited today. This report is reviewed and discussed with the administrator and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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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