Facility Evaluation Report

In response to application for capacity increase from 6 to 10 beds, LPA Jeung inspected physical plant and observed residents. Fire clearance has been approved for 7 non-ambulatory and 3 bedridden elderly persons. Staff reside on the upper level of this 2 story home; there are 2 beds in each room. According to administrator, Ms. Leslie, staff are awake at night. There is a full bathroom on the 2nd floor for staff. On the ground level, there are 6 bedrooms and 4 bathrooms; 3 bathrooms are designated for residents and one is for staff use. Two rooms were constructed on the east side of house. A partial wall has been erected dividing the large rear bedroom on the west side of the house; there is an 8 inch open space above the wall, so the rooms are NOT fully enclosed as bedrooms, as required by San Bruno City Planning Dept.

Deficiencies of the California Code of Regulations, Title 22 are observed and cited on a following page>

The following forms are requested to be submitted to CCLD by 10/31/22:

- Emergency Disaster Plan (LIC610E)-- must be maintained in facility

Approval of capacity increase is pending receipt of the above referenced items and numbers added to client rooms. Bedrooms are not identified by number. Numbers to be added to bedroom doors for identification. The bedroom with the partial wall can be numbered and designated "A" and "B".

Ms. Leslie is advised that an emergency signal system is required if staff are NOT awake at night.