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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601038
Report Date: 02/18/2025
Date Signed: 02/18/2025 11:28:16 AM

Document Has Been Signed on 02/18/2025 11:28 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:SUNVILL BOARD AND CARE IIFACILITY NUMBER:
415601038
ADMINISTRATOR/
DIRECTOR:
VILLARAZA, LOUELFACILITY TYPE:
740
ADDRESS:771 CAMARITAS AVETELEPHONE:
(650) 278-0008
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:36 AM
MET WITH:Louel VillarazaTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 2/18/25 LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Louel Villaraza. LPA explained the purpose of the visit.

Facility is a 4 bedroom house with 2 shared rooms. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. Residents are currently resting in the bedrooms and living room. The residents have adequate amount of linens and all personal belongings are intact. While touring the facility it was observed that the room temperature was at 69 deg F. Hot water was also tested in the bathrooms and the temperature was 106 deg F. Carbon monoxide monitor is working properly. All fire extinguishers have been checked and current. Client bathrooms were observed to be in good repair equipped with grab bars and non-skid floors. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Emergency drills are done quarterly.

Five resident records and three staff records were reviewed. Everything is complete and updated. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated.

LPA received the following documents: LIC500, LIC308, Administrator Certificate, Liability Insurance and LIC610E. LPA requested the following to be emailed, Copy of Deed.

No deficiencies are cited at this time. Report is reviewed and a copy is provided.
Andrea MedlinTELEPHONE: (650) 266-8811
Grace DonatoTELEPHONE: (714) 293-8294
DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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