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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601011
Report Date: 04/24/2024
Date Signed: 04/24/2024 10:44:24 AM

Document Has Been Signed on 04/24/2024 10:44 AM - 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:ALLIANCE CARE HOMEFACILITY NUMBER:
415601011
ADMINISTRATOR/
DIRECTOR:		MONTIEL, ALDOFACILITY TYPE:
735
ADDRESS:935 FOOTHILL DRIVETELEPHONE:
(415) 606-3215
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 4CENSUS: 4DATE:
04/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:14 AM
MET WITH:Aldo Montiel, Administrator/Licensee and Diem Nguyen, NurseTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On April 24, 2024, at 10:14 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to clear a deficiency (missing refrigerator thermometer or temperature gauge). LPA Calandra was greeted by Diem Nguyen, Nurse and explained the purpose of the visit. Aldo Montiel, Administrator/Licensee arrived later during the visit.

During the visit, LPA Calandra observed thermometers in both the refrigerator and freezer.

No deficiencies were cited during today's visit.

This report was reviewed with Aldo Montiel, Administrator/Licensee and a copy of the report left at the facility.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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