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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600823
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:49:49 AM

Document Has Been Signed on 03/04/2025 11:49 AM - 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:EMERALD RESIDENTIAL CARE HOMEFACILITY NUMBER:
415600823
ADMINISTRATOR/
DIRECTOR:		GIL, ISABELLE B.FACILITY TYPE:
740
ADDRESS:1749 NEWBRIDGE AVENUETELEPHONE:
(650) 348-3054
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 6CENSUS: 6DATE:
03/04/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Isabelle Gil, Elnora Panilag, Esterlina DumanagTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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LPA Jeung monitored corrections of deficiencies cited on 2/27/25--for which plans/proof of corrections were due on 2/28/25--and 2/25/25--for which civil penalties were assessed.

The following deficiency, which was cited on 2/25/25, still exists:

Section 87303(e)(2) Maintenance and Operation
- Hot water temperature tested at 125 degrees in client bathroom
-- Civil penalty of $100/day continues to accrue daily until deficiency is corrected and CCLD is notified
-- Civil penalty of $600 is assessed today for period 2/27/25 - 3/4/25

The following deficiencies, which were cited on 2/27/25, still exist:

Section 87217(g)(1) Safeguards for Resident Cash
- Plan of correction for plan to maintain clients' P & I monies current and accurate was not submitted
-- Civil penalty of $100 is assessed today, and will continue to be assessed daily until deficiency is corrected and CCLD is notified
-- Civil penalty of $400 is assessed today for period 3/1/25 - 3/4/25

Health and Safety Code 1569.695
- Plan of correction for implementation of quarterly emergency disaster drills was not submitted
-- Civil penalty of $100 is assessed today, and will continue to be assessed daily until deficiency is corrected and CCLD is notified
-- Civil penalty of $400 is assessed today for period 3/1/25 - 3/4/25
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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