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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
415601083
Report Date:
06/17/2024
Date Signed:
06/17/2024 04:55:02 PM
Document Has Been Signed on
06/17/2024 04:55 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:
JUDY'S CARE HOME FOR THE ELDERLY
FACILITY NUMBER:
415601083
ADMINISTRATOR:
ROIAS, MARIA E
FACILITY TYPE:
740
ADDRESS:
125 A 24TH AVENUE
TELEPHONE:
(650) 345-6753
CITY:
SAN MATEO
STATE:
CA
ZIP CODE:
94403
CAPACITY:
6
CENSUS:
5
DATE:
06/17/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
04:45 PM
MET WITH:
Marissa Milanes
TIME COMPLETED:
04:46 PM
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SUPERVISOR'S NAME:
Andrea Medlin
TELEPHONE:
(650) 266-8811
LICENSING EVALUATOR NAME:
Grace Donato
TELEPHONE:
(714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE:
06/17/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/17/2024
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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