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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
415601092
Report Date:
03/11/2025
Date Signed:
03/11/2025 02:16:44 PM
Document Has Been Signed on
03/11/2025 02:16 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:
ALEXEI'S HOME
FACILITY NUMBER:
415601092
ADMINISTRATOR/
DIRECTOR:
FLORES, VICTORIA
FACILITY TYPE:
735
ADDRESS:
140 OAKFIELD AVENUE
TELEPHONE:
(650) 307-3607
CITY:
REDWOOD CITY
STATE:
CA
ZIP CODE:
94061
CAPACITY:
3
CENSUS:
3
DATE:
03/11/2025
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:
Mae Flores
TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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LPA Jeung met with administrator Mae Flores at ANDREI'S HOME #419210078, located at 1613 Church Avenue, San Mateo, and delivered letter of immediate exclusion for staff #1.
SUPERVISORS NAME
:
April Cowan
LICENSING EVALUATOR NAME
:
Audrey Jeung
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/11/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/11/2025
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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