Senior Care Records.

Facility Evaluation Report

Fhar - Acacia Avenue Home, San Bruno04/10/2025Licence 410508909

Capacity6
Census6
Date signed04/13/2025 09:14:57 PM
Name of licensing program analystGrace Donato
Name of licensing program managerAndrea Medlin
The inspector’s account

On 4/10/2025, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced case management - other visit in order to deliver an exclusion letter. LPA met with House Manager, Harry Smith and explained the purpose of the visit.

LPA provided the letter and discussed the reason of the letter. Staff (S1) was escorted out of the facility. House Manager was advised that S1 is not allowed to work or enter the facility.

Report is reviewed and a copy is provided.

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