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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601141
Report Date: 11/16/2022
Date Signed: 11/16/2022 11:41:04 AM


Document Has Been Signed on 11/16/2022 11:41 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
SF COASTAL AC/SC, 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:
11/16/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Administrator, Susan TilmaTIME COMPLETED:
11:50 AM
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On 11/16/2022, Licensing Program Analyst (LPA) Murial Han conducted a follow-up pre-licensing inspection from the initial pre-licensing that was done on 10/25/2022. LPA met with lead staff, Averelle Aban and the administrator, Susan Tilma arrived shortly thereafter to complete the inspection.

During today's inspection, lead staff provided a tour of the facility and LPA inspected the area of concerns that were identified during the initial inspection. LPA observed the medication, and the chemical/toxins were appropriate stored, locked and inaccessible to residents. The first-aid kit is inspected and complete. The kitchen sink, the bath/shower rooms water temperature were measured at 105.1 to 105.8 degrees Fahrenheit (F).

As a result of today's inspection, the area of concerns from the initial inspection have been resolved. Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau.

Comp III orientation was given to the Administrator, Susan Tilma and Lead Staff, Averelle Aban.

This report is reviewed and discussed with the administrator.

A copy of the report is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022
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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