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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601168
Report Date: 02/20/2025
Date Signed: 02/20/2025 11:25:39 AM

Document Has Been Signed on 02/20/2025 11:25 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:WELCOME HOMEFACILITY NUMBER:
415601168
ADMINISTRATOR/
DIRECTOR:		YEMA, HERMIEFACILITY TYPE:
735
ADDRESS:117 ARROYO DRTELEPHONE:
(650) 757-7725
CITY:S SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 6CENSUS: 0DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:39 AM
MET WITH:Hermie YemaTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 2/20/2025, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced annual visit to the facility. LPA met with Administrator Hermie Yema and explained the purpose of the visit.

Facility is a single level with 6 bedrooms, 2 full baths and staff rooms. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA observed the indoor and the outdoor passageways are free of obstruction. All rooms are observed with required furniture and lighting, Bathrooms are still in good repair.

Facility lighting is sufficient for comfort and safety. LPA toured the kitchen area and observed it to be clean. Facility refrigerator temperatures are within regulatory standards. Chemicals & sharps have their own locked storage. Carbon monoxide was tested and fire extinguishers are up to date.

Facility is still pending vedorization with Golden Gate Regional Center so there are no available records to review. Facility is still clean and well kept based on observations made today.

No deficiencies are cited at this time. Report is reviewed and a copy is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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