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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202504
Report Date: 05/03/2021
Date Signed: 05/03/2021 11:24:22 AM

Document Has Been Signed on 05/03/2021 11:24 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
CCLD Regional Office,
, CA
FACILITY NAME:WEBSTER HOUSEFACILITY NUMBER:
435202504
ADMINISTRATOR:HIBBS, LINDAFACILITY TYPE:
741
ADDRESS:401 WEBSTER STREETTELEPHONE:
(650) 327-4333
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY: 54CENSUS: 41DATE:
05/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Linda HibbsTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) David Marrufo and Nurse Roxane Fangon conducted a tele-visit via Zoom to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPA Marrufo, and Nurse Roxane Fangon met with Administrator Linda Hibbs.

The Administrator reports that there are currently 0 COVID-19 positive residents and 0 COVID-19 positive staff.

During today's tele-visit, the following recommendations were made to the facility by Nurse Roxane Fangon:

1. Continue facility COVID-19 mitigation practices.



No deficiencies were cited as per California Code of Regulations, Title 22. This report was reviewed with with Garret Johnson. A copy of the report will be sent to him for it to be signed and returned to CCL
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2021
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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