Facility Evaluation Report

Five Star Care Home II, Foster City07/11/2025Licence 415600705

Capacity6
Census6
Date signed07/11/2025 01:32:35 PM
Name of licensing program analystMurial Han
Name of licensing program managerApril Cowan
The inspector’s account

On 7/11/2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced plan of correction visit to follow on a civil penalty that was assessed on 7/3/2025. LPA met with the caregiver, Irma Perez and explained the purpose of today's visit.

On 7/3/2025, LPA conducted an unannounced Plan of Correction visit to follow up on the citations that were issued during the annual visit on 6/17/2025. During the visit, LPA observed these deficiencies were not corrected:1569.625(b)(2)Other Provisions, 1569.695(c) Other Provisions, 87608(a)(3) Postural Supports, therefore, a civil penalty in the amount of $3300 was assessed from 6/18/2025 - 6/28/2025.

During today's visit, LPA observed the above citations were corrected and civil penalty has been stopped on 6/29/2025.

In addition, LPA also observed the citation that was cited on 7/3/2025 87355(a) Criminal Background Clearance has been corrected.

This report is reviewed and discussed with caregiver; A copy is provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction