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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202504
Report Date: 06/07/2021
Date Signed: 06/07/2021 12:05:29 PM

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:
06/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Linda HibbsTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced COVID-19 Infection Control Required 1 Year visit and met with Administrator Linda Hibbs.

During visit, LPA Marrufo toured the facility entrance and screening area, bathrooms, facility staff break area, dinning area, and hallways. Three out of three observed bathrooms
did not have trash cans with foot operated lids. Facility staff were observed to have masks. Facility was observed to have an adequate supply of PPEs.

A Technical Advisory Note was issued. See LIC9102 for more information.

No deficiencies were cited as per California Code of Regulations, Title 22.


This report was reviewed with Administrator Linda Hibbs and a copy of the report was provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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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