Senior Care Records.

Facility Evaluation Report

Peninsula Elderly Care Home-laurel LLC, San Carlos05/22/2025Licence 415601034

Capacity12
Census6
Date signed05/22/2025 03:08:44 PM
Name of licensing program analystJohn Calandra
Name of licensing program managerApril Cowan
The inspector’s account

On 5/22/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Rolly Tabago, Caregiver and Evelyn Tabago, Caregiver and explained the purpose of the visit. Jennifer Tobias, Administrator arrived later during the visit.

LPA toured the physical plant. This is a 1-story building with 7 bedrooms, 3 bathrooms, a living room, dining room, kitchen, laundry room, garage, front and back yards. All bedrooms had the required furniture and sufficient lighting. Bathrooms had the required anti-skid floor mats and shower bars. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. The facility's first aid kit was observed to have all required items. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's fire extinguishers were observed to be fully charged and last checked on 4/8/2025.

Sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care.

The Annual Inspection will be completed at a later date.

Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties.

An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator, and a copy of the report along with Appeal Rights left at the facility.

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