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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601173
Report Date: 01/28/2025
Date Signed: 01/28/2025 11:48:05 AM

Document Has Been Signed on 01/28/2025 11:48 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:JERRY'S CARE HOMEFACILITY NUMBER:
415601173
ADMINISTRATOR/
DIRECTOR:		BRANCH, KAILAFACILITY TYPE:
735
ADDRESS:2501 OAKMONT DRIVETELEPHONE:
(650) 636-4048
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: 6CENSUS: 0DATE:
01/28/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator, Kaila BranchTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On January 28, 2025, Licensing Program Analyst (LPA) Murial Han conducted a follow-up pre-licensing inspection. LPA met with administrator, Kaila Branch and explained the purpose of today's visit.

During today's visit, LPA toured the facility with administrator and observed auditory devices installed on the exterior doors and the rooms are labeled according to the fire clearance inspection.

Comp III orientation was given to the Administrator during the initial visit on 1/16/2025.

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: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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