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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601159
Report Date: 09/28/2023
Date Signed: 09/28/2023 10:07:41 AM

Document Has Been Signed on 09/28/2023 10:07 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:MARIAH'S GARDEN HOME CARE 2FACILITY NUMBER:
415601159
ADMINISTRATOR:ZEPEDA, MARIAFACILITY TYPE:
740
ADDRESS:195 CASTILLEJO DRIVETELEPHONE:
(650) 797-7951
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 6CENSUS: 0DATE:
09/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, Maria ZepedaTIME COMPLETED:
10:15 AM
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On September 28, 2023 Licensing Program Analyst (LPA) Murial Han conducted a follow-up pre-licensing inspection. LPA met with administrator, Maria Zepeda and explained the purpose of today's visit.

During today's visit, LPA toured the facility with administrator and observed fire place is covered, there are outdoor furniture in the backyard for outdoor activities and residents can utilize the balcony from stairs in the backyard, all bed rooms are furnished with adequate furniture, facility temperature is comfortable and bathroom faucets are working properly.

Comp III orientation was given to the Administrator.

Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau.

Exit interview conducted with administrator.

A copy of the report is provided.



SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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