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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601137
Report Date: 10/04/2023
Date Signed: 10/04/2023 02:36:27 PM

Document Has Been Signed on 10/04/2023 02:36 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SANDHILL ASSISTED LIVING LLCFACILITY NUMBER:
415601137
ADMINISTRATOR:TILMA, SUSANFACILITY TYPE:
740
ADDRESS:735 MONTE ROSA DRIVETELEPHONE:
(650) 492-9429
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 6CENSUS: DATE:
10/04/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Susan Tilma & Diana CovichTIME COMPLETED:
02:45 PM
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On 10/4/23 San Bruno Regional Office conducted a non-compliance conference meeting with Licensees, Susan Tilma & Diana Covich.

Present in the meeting was Regional Manager, Vivien Helbling, Licensing Program Manager, Jackie Jin, and Licensing Program Analyst, Grace Donato.
 
During non-compliance meeting, the following violations were discussed, Personal Rights of Residents in All Facilities, Facility dog presented aggression toward a family member and bit the family member. Personnel Requirements – General and Personnel Records for records were not readily available in the facility. Administration and management of residential care facilities; substituted qualifications; employee scheduling, for two staff members doesn't have valid CPR training due to validity being expired.
Emergency Plans for not having completed emergency drill log as required. Reporting Requirements
for resident reported to Licensing that he/she fell several times and no incident report was submitted by the Licensee.

During this meeting, it was discussed, Licensee will receive more frequent monitoring inspection visits to ensure compliance with this compliance plan and Title 22 Regulations for 2 years. Licensee was provided the link below for resources and guidance to improve facility operations: 
https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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