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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 419200005
Report Date: 09/20/2024
Date Signed: 09/20/2024 03:44:04 PM

Document Has Been Signed on 09/20/2024 03:44 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:ALBRIGHT HOMEFACILITY NUMBER:
419200005
ADMINISTRATOR/
DIRECTOR:		ANCHETA, KERSTENFACILITY TYPE:
735
ADDRESS:2501 ALBRIGHT WAYTELEPHONE:
(650) 588-2962
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 6CENSUS: 2DATE:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Adora AnchetaTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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On 9/20/24, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Licensee Adora Ancheta and LPA explained the purpose of the visit.

LPA toured the facility inside and outside including all of resident rooms, garage, and kitchen area. Residents are currently in day program. While touring the facility it was observed that the room temperature was at 69 deg F. Hot water was also tested in the bathrooms and the temperature was 107 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked. Food supply was observed with an adequate two day perishable and seven day non-perishable. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility.

Two resident records and three staff records were reviewed. Resident’s PNI money was counted and all accounted for with proper log and receipts. Centrally stored medication was checked and are complete and updated. Facility has certified administrator.

LPA requested the following documents: LIC308, LIC500, LIC400, Surety Bond, LIC610D & Control of Property by 9/23/2024.

No deficiencies cited today. Report is reviewed and copy is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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