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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600835
Report Date: 03/05/2025
Date Signed: 03/05/2025 05:15:15 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/05/2025 05:15 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:AGEWAY BOARDING CARE #2FACILITY NUMBER:
415600835
ADMINISTRATOR/
DIRECTOR:		DAYEH, ANAFACILITY TYPE:
740
ADDRESS:1325 ROYAL AVENUETELEPHONE:
(650) 315-2621
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 6CENSUS: 4DATE:
03/05/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Grace Tolentino and Ryan AbrenciaTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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LPA Jeung reviewed staff records to complete annual inspection of 10/10/24.
There are 3 certified RCFE administrators associated to facility with active status, per CCLD Administrator Certification Unit.

Copy of complete and signed lease agreement is requested to be sent to CCLD within TEN days.

No deficiencies of the California Code of Regulations, Title 22 are observed.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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