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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601137
Report Date: 01/16/2024
Date Signed: 01/16/2024 02:02:45 PM

Document Has Been Signed on 01/16/2024 02:02 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: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: 5DATE:
01/16/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Ricardo AbanTIME COMPLETED:
11:30 AM
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On 1/16/24, Licensing Program Analyst (LPA), Grace Donato conducted an unannounced case management- legal/non-compliance inspection to monitor the facility operation. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit.

A non-compliance conference was held on October 4, 2023. During non-compliance meeting, the following violations were discussed Personal Rights of Residents in All Facilities, Personnel Records, Emergency Drills, Reporting Requirements.

During LPAs visit it was observed that residents were watching tv in the living room. The dogs are not in the facility anymore and were moved somewhere else. First Aid training's are updated. Emergency drill training was done using Gerboth Fire & Safety Inc. Reporting requirements has been followed, Facility is constantly reporting incidents.

No citations issued today.

Report is reviewed with Administrator and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
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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