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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600910
Report Date: 09/27/2024
Date Signed: 09/27/2024 02:24:41 PM

Document Has Been Signed on 09/27/2024 02:24 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: 5DATE:
09/27/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Administrator, Dee LeteTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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On September 27, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management- health and safety visit to ensure clients have been relocated safely back to the facility. LPA met with Administrator, Dee Lete and explained the purpose of the visit.

On 9/24/26, facility had to relocate all clients from the home to a hotel located in San Carlos due to termite issues. The entire house, inside and out was fumigated on 9/24/24-9/26/24. Clients moved back to the facility on 9/26/24 in the evening after clients returned back from their day program.

During the visit today, LPA observed 2 clients on the couch with two staff members present. Facility was clean and odor-free. A comfortable temperature was maintained. LPA observed medication, chemicals and sharps to be locked and inaccessible to clients. Food supply was observed to be sufficient. Clients all had their personal belongings in all their rooms.

No deficiencies cited during the visit. Report is reviewed with Administrator and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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