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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601131
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:14:15 PM

Document Has Been Signed on 12/05/2023 03:14 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:CANYON PLACEFACILITY NUMBER:
415601131
ADMINISTRATOR:GADDI, PORTIAFACILITY TYPE:
740
ADDRESS:817 CANYON RDTELEPHONE:
(650) 299-1057
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY: 6CENSUS: 6DATE:
12/05/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Portia GaddiTIME COMPLETED:
03:30 PM
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced post licensing inspection. This facility was originally licensed in October 2022. LPA met with administrator Portia Gaddi and explained the purpose of today's visit.

During today's visit LPA toured the facility with Portia and made observations through out the facility and the exterior surrounding areas of the facility. LPA observed that the fireplace is covered with a screen and TV blocking access to the fireplace. The fireplace is not used. The emergency exits around the facility are clear of obstructions and fences are not locked. Outdoor furniture in the backyard are in good condition for resident, staff, and visitor use. All resident rooms are furnished with the required furniture outlined in regulations. These items are observed as in good repair. The facility ambient temperature is comfortable for residents and visitors. Bathrooms are observed as operational. Water is tested in a common bathroom in the hallway and kitchen sink measuring at 105F. Those faucets are operating properly. Fire extinguishers are observed as charged and in working condition per the dial. Carbon monoxide and smoke detectors are observed through out the facility. Facility is equipped with full sprinkler system through out. Medications are locked and knives are locked away appropriately. Cleaning supplies are locked as well in the garage. Food supplies are in place. Resident and staff files are reviewed as complete and current. Staff training is current. Facility does not handle resident monies. Administrator certificate is observed as current expiring 04/23/2025. Disaster drills are conducted quarterly per log reviewed.

Report is reviewed with Portia.

No citations issued.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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