<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601159
Report Date: 09/17/2024
Date Signed: 09/17/2024 02:07:45 PM

Document Has Been Signed on 09/17/2024 02:07 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:MARIAH'S GARDEN HOME CARE 2FACILITY NUMBER:
415601159
ADMINISTRATOR/
DIRECTOR:		ZEPEDA, MARIAFACILITY TYPE:
740
ADDRESS:195 CASTILLEJO DRIVETELEPHONE:
(650) 797-7951
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 6CENSUS: 4DATE:
09/17/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Maria Zepeda, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On September 17, 2024, Licensing Program Analysts (LPAs) Kiran Jain and Komal Charitra arrived at the facility to conduct a Plan of Correction (POC) visit with regards to the citation given to the facility during an Annual inspection conducted on 09/10/2024. LPAs met with Maria Zepeda, Administrator and explained the purpose of the visit.

On 09/10/2024, LPAs Jain And Charitra cited the facility for CA code of regulations section 87307(a)(2)(B) for Personal Accommodations and Services. During the visit conducted on 09/10/2024, LPAs observed 2 beds in the garage used as a sleeping area for a staff member.

During today’s visit LPAs didn’t observe any beds in the garage. The garage was observed to be clean and clear of any fire safety hazards. The deficiency has been corrected and cleared.

Report is reviewed and copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1