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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600870
Report Date: 04/04/2024
Date Signed: 04/04/2024 12:52:31 PM


Document Has Been Signed on 04/04/2024 12:52 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:SWEETWOOD HOMEFACILITY NUMBER:
415600870
ADMINISTRATOR:ROBERTO BALAUROFACILITY TYPE:
735
ADDRESS:1311 SWEETWOOD DRIVETELEPHONE:
(650) 703-1217
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:4CENSUS: 4DATE:
04/04/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Ionna Dale, Direct Support Professional and Roberto Balauro, AdministratorTIME COMPLETED:
01:00 PM
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On April 4, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:36 AM to complete the Annual Inspection. LPA Calandra was greeted by Ionna Dale, Direct Support Professional(DSP) and explained the purpose of his visit. Robert Balauro, Administrator arrived later during the visit.

Personal & Incidental (P&I) money kept on hand at the facility for clients, matched the records kept on hand at the facility.

Hot water temperature was measured at 113 degrees Fahrenheit. Well within the required 105-120 degrees Fahrenheit.

LPA Calandra reviewed 5 staff files most were observed to be complete. One was missing TB results but signed by the staff member's physician.

LPA Calandra interviewed 2 residents and 2 staff.

A Technical violation was provided for not having a written directive from residents' in care's physician who are prescribed Pro Re Nata(PRN-as needed)s.

No deficiencies were cited during today's visit.

This report was reviewed with Ionna Dale, DSP and Roberto Balauro, Administrator and a copy of the report left at the facility.





SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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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