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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600979
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:37:20 PM

Document Has Been Signed on 09/30/2024 02:37 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:GRATIA HOMEFACILITY NUMBER:
415600979
ADMINISTRATOR/
DIRECTOR:		LETRONDO, LILIBETHFACILITY TYPE:
735
ADDRESS:2585 WENTWORTH DRIVETELEPHONE:
(650) 580-1266
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 4CENSUS: 3DATE:
09/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Manager, Veronica CochonTIME VISIT/
INSPECTION COMPLETED:
02:48 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 30, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit. LPA met with House Manager, Veronica Cochon and explained the purpose of the visit.

The purpose of today's visit is to deliver an immediate exclusion letter to exclude Staff #1 (S1) from the facility.

The letter was given to the House Manager.

This report is reviewed and discussed with the House Manager and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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