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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601141
Report Date: 05/24/2024
Date Signed: 05/24/2024 11:30:37 AM


Document Has Been Signed on 05/24/2024 11:30 AM - 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:
415601141
ADMINISTRATOR:TILMA, SUSANFACILITY TYPE:
740
ADDRESS:1239 MIDDLE AVETELEPHONE:
(650) 796-9921
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:6CENSUS: 5DATE:
05/24/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Ricardo AbanTIME COMPLETED:
12:00 PM
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On 5/24/24, 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 Reporting Requirements, Care of Persons with Dementia, Personnel Requirements.

During LPAs visit, it was observed that care staff are currently doing some ADLs (Activities of Daily Living) for some residents. Some residents are also resting in their respective rooms. Care of Persons with dementia training is still up to date. Facility is consistent with reporting requirements, staff has been constantly reporting incidents and then submitted to Licensing. Staffing is currently enough to cater to residents in the facility. No need for night shift at the moment but will be addressed by Licensee if needed.

No citations issued today.

Report is reviewed with Administrator and a copy is provided.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
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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