<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600910
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:18:32 PM

Document Has Been Signed on 09/24/2024 01:18 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:ANYA'S HOMEFACILITY NUMBER:
415600910
ADMINISTRATOR/
DIRECTOR:		LETE, EUGENIOFACILITY TYPE:
735
ADDRESS:841 ALAMEDA DE LAS PULGASTELEPHONE:
(650) 620-9695
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY: 6CENSUS: 0DATE:
09/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:07 PM
MET WITH:Administrator, Dee LeteTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On September 24, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit. LPA met with Administrator, Dee Lete and explained the purpose of the visit.

On 9/17/2024, administrator notified LPA Charitra that facility was going to relocate all five clients to a hotel in San Carlos due to termite issues. According to the administrator, the facility was going to relocate all clients on 9/24/2024 and return back home on 9/26/2024.

During the visit, LPA observed the facility inside and out. Two fumigation trucks were observed in the driveway. Backyard was observed to be tented. Garage door and house front door was observed with danger fumigation signs posted. House was observed to be tented in the front. LPA spoke to administrator who indicated that the fumigators requested to have all the cabinets in the home to be open during the fumigation process.

No deficiencies are cited during the visit. Report is reviewed with the Administrator and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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 1