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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601175
Report Date: 11/09/2023
Date Signed: 11/09/2023 04:00:22 PM

Document Has Been Signed on 11/09/2023 04:00 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:TLC HOME CAREFACILITY NUMBER:
415601175
ADMINISTRATOR:MAURICIO, LILIA LFACILITY TYPE:
740
ADDRESS:716 NORTH HUMBOLDT STTELEPHONE:
(650) 952-1687
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 6CENSUS: 5DATE:
11/09/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Lillie MauricioTIME COMPLETED:
04:00 PM
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On November 9, 2023, San Bruno Regional Office conducted a non-compliance conference meeting with Licensee/Administrator, Lilia Mauricio.

Present in the meeting are Regional Manager, Vivien Helbling, Licensing Program Managers, Cara Smith, and April Cowan, Licensing Program Analysts, Grace Donato, Audrey Jeung and John Calandra, Long Term Care Ombudsman Robert Lewitzon are also present in this meeting.
 
Licensee is provided the link below for resources and guidance to improve facility operations: 
  
https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers


Report was reviewed with Licensee/Administrator, Lilia Mauricio and copies are provided.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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