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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601139
Report Date: 12/15/2023
Date Signed: 12/15/2023 03:12:17 PM


Document Has Been Signed on 12/15/2023 03:12 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:TLC PACIFICAFACILITY NUMBER:
415601139
ADMINISTRATOR:TOPIRCEANU, CRISTIANFACILITY TYPE:
740
ADDRESS:689 LADERA WAYTELEPHONE:
(714) 916-7342
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:16CENSUS: 14DATE:
12/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cristian Topirceanu, Administrator/LicenseeTIME COMPLETED:
03:15 PM
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On December 15, 2023, Licensing Program Analysts John Calandra and Grace Donato arrived at the facility to conduct the required 1-year Annual Inspection. LPAs Calandra and Donato met with Administrator, Cristian Topirceanu.

LPAs toured the physical plant which consists of 11 bedrooms(10 for residents and 1 staff bedroom) and 5 bathrooms, front and backyards, an office, living room, kitchen, 2-car garage, and dining room. Bedrooms were observed to have sufficient lighting and the required furniture. No accessible bodies of water were observed and hallways were observed to be free and clear of hazards. The facility has 7 days of non-perishables and 2 days of perishables on site. No food is expired. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. Water temperature was measured above the required range but the Licensee/Administrator adjusted the temperature in the presence of the LPA. All fire alarms, door alarms, and carbon monoxide detectors were observed to be in good operation. The facility is equipped with sufficient exit lighting/night lights. All fire extinguishers were observed to be fully charged and last inspected on March 1, 2023.

All sharp objects, detergents, and soap were locked up and in-accessible to persons in care.

All medications were observed to be locked up and in-accessible to persons in care.

LPAs reviewed 5 resident and 3 staff files. All were observed to be complete and in order

LPAs also interviewed 3 residents and 2 staff.

No deficiencies were cited during today's visit. This report was reviewed with the Administrator, Cristian Topirceanu and a copy provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023
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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