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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600925
Report Date: 12/18/2024
Date Signed: 12/18/2024 01:27:22 PM

Document Has Been Signed on 12/18/2024 01:27 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:CALIFORNIA ASSISTED DEVELOPMENT LLCFACILITY NUMBER:
415600925
ADMINISTRATOR/
DIRECTOR:
LOCHIN, STACYFACILITY TYPE:
775
ADDRESS:3641 HAVEN AVENUE, STE ATELEPHONE:
(415) 573-7031
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 40CENSUS: 15DATE:
12/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator, Stacy LochinTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On December 18, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual visit. LPA met with Administrator, Stacy Lochin and explained the purpose of the visit.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. The day program has two floors; 4 activity/classroom areas, main activity room, kitchen, and bathrooms located on first floor and a computer lab and conference area located on the second floor. According to the Administrator, clients that go to the second floor to use the computers are always supervised by staff members. Activity rooms were observed to be clean, clear from tripping hazards, and spacious. During the visit, LPA observed clients in the patio outside eating their lunch. There were 15 clients present and 6 staff members during the visit.

LPA observed two separate bathrooms for women and men; two sinks in each bathroom. Bathrooms were clean and odor-free; equipped with liquid soap and paper towels. LPA observed the hot water handle on the right side sink not working in both the men's and women's bathroom. Hot water temperature throughout the facility measured at 115 degrees F. Overall facility maintained a comfortable temperature and lighting was sufficient for comfort. Kitchen door is locked at all times, however during the visit, a staff member was warming up food for the clients. According to a staff member, clients bring their lunches to the day program. Clients are able to store their lunches in the refrigerator. Sharps, toxins, and chemicals were observed to be locked and inaccessible to clients. At the time, there are no clients who take medication at the program. LPA checked all fire extinguishers which were inspected on 11/2024. First aid kit was observed to be present.

Disaster drills are observed being conducted monthly. LPA reviewed 4 client files and 4 staff files. Client records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement.

No citations are issued 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: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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