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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601186
Report Date: 11/01/2024
Date Signed: 11/01/2024 04:05:28 PM

Document Has Been Signed on 11/01/2024 04:05 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:MARIA'S SENIOR CARE HOMEFACILITY NUMBER:
415601186
ADMINISTRATOR/
DIRECTOR:
BARTOLI, MARIAFACILITY TYPE:
740
ADDRESS:419 TOPAZ STREETTELEPHONE:
(510) 378-2194
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY: 6CENSUS: 5DATE:
11/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Maria Bartoli, Administrator and Ronel Sangil, CaretakerTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On November 1, 2024, at 8:30 AM, Licensing Program Analyst(LPA) John Calandra, arrived at the facility to conduct an unannounced pre-licensing visit. LPA Calandra was greeted by Ronel Sangil, Caretaker and explained the purpose of the visit. Applicant, Maria Bartoli arrived later during the visit.

LPA Calandra conducted a physical plant tour. The facility consists of 4 bedrooms, 2 bathrooms, a garage, 2 staff rooms, living room, kitchen, and dining room. Water temperature was measured at 126 degrees Fahrenheit. Ronel Sangil, Caretaker turned down the water temperature in the presence of the LPA. The bedrooms were observed to have sufficient lighting and the required furniture. All bathrooms were observed to have the required grab bars and anti-skid floor mats. The facility had linens on hand for clients that were observed to be in good condition. The facility had the required 7 days of non perishables and 2 days of perishables on hand. No food was expired. No accessible bodies of water or hazards were observed in the front yard, backyard, or hallways. The facility's Carbon Monoxide and Smoke detectors were observed to be in working condition. The fire extinguisher was observed to be fully charged.

A component III was performed with the Applicant.

LPA Calandra asked the Applicant to address the following:

-Place night lights in hallways
-Ensure water temperature is lowered to between 105 and 120 degrees Fahrenheit
-Fix tile on side of house
-Clear a pathway in Garage if needed for emergency evacuation
-Place a Thermometer in each fridge and freezer
-Place a Thermometer and Current edition of First Aid Manual approved by the American Red Cross, the American Medical Association, or a State or Federal Health Agency in the First Aid Kit
-Remove bed and frame in garage
-Ensure all door alarms are operational
-Ensure all resident and staff files have the required Licensing documents
-Fix faucet in bathroom between bedrooms 1 and 2
-Fix leaking dishwasher in Kitchen

LPA will return to conduct a follow-up visit to ensure the above items have been addressed.

No deficiencies were cited during today's visit.

The report was reviewed with Maria Bartoli, Applicant. A copy of the report was left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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