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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600900
Report Date: 02/24/2023
Date Signed: 02/24/2023 12:29:42 PM


Document Has Been Signed on 02/24/2023 12:29 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:ABIGAIL COMPLETE CARE, INCFACILITY NUMBER:
415600900
ADMINISTRATOR:FRAGIACOMO, VIVIANFACILITY TYPE:
740
ADDRESS:1230 HOPKINS AVENUETELEPHONE:
(650) 224-8853
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:24CENSUS: 23DATE:
02/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Vivian FragiacomoTIME COMPLETED:
12:45 PM
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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced infection control annual inspection. LPA met with administrator Vivian Fragiacomo and explained purpose of today's inspection.

Prior to entry LPA was tested for COVID via rapid testing. LPA was screened appropriately prior to entry. COVID spread prevention signs are placed through out the facility and main gate. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is observed as in place stored through out the facility via substations. There is also PPE stored in storage closets in main dining room area. Staff is observed wearing masks through out the facility. Daily resident temperature checks are being conducted as well as staff's. Mitigation and infection control plans are current and being followed.

There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients. Facility ambient temperature is warm and comfortable, and lighting is sufficient for residents and staff safety. Toilet and bathing facilities are equipped with grab bars and non-skid mats. LPA observed two shower rooms one adjacent to room 20 and another adjacent to room 12. Shower rooms have pull cords present. Liquid soap and paper towels are present in resident room bathrooms observed. LPA observed resident rooms 10, 12, and 20 which also have pull cords in place. Resident rooms observed contain all required furnishings and lighting. Facility has three first-aid kits that are in place. A Disaster and Mass Casualty Plan is observed. Food supplies are observed as in place in main kitchen and storage area. Two day perishable and one week non-perishable food supplies are observed as in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact are current. Fire extinguishers inspected are current with inspection tags dated 04/04/2022. Carbon monoxide detectors are observed as in place through out the facility.

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SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2023
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


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ABIGAIL COMPLETE CARE, INC
FACILITY NUMBER: 415600900
VISIT DATE: 02/24/2023
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Page 2 - LIC809

The following updated forms are requested to be submitted to CCLD by 03/03/2023:

• Updated Administrator Certificate
• LIC 308 Designation of Administrative Responsibility
• LIC 500 Personnel Report
• LIC 610E Emergency Disaster Plan

No citations issued. Report is reviewed the administrator Vivian Fragiacomo.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2