Facility Evaluation Report

LPA Jeung toured facility and grounds of this one level facility. There are 3 shared client bedrooms, a staff room with one bed for 2 persons, 3 full bathrooms--2 for resident use--small living room, dining/family room, kitchen and 2-car garage. The spacious yard is level, fenced and partially paved. There are two detached storage sheds in backyard that contain household items and chemicals. There is also a large building used currently for storage. Per San Mateo city Code Enforcement, this building cannot be inhabited without a permit. Licensee to keep licensing agency informed as to the proposed use of building.

Fresh and non-perishable food supplies are observed. First aid kit is observed complete. Hot water temperature is tested at 113 degrees in clients' bath/shower room. Carbon monoxide/smoke detector is tested and operable. There is a fire extinguisher in the kitchen.

Medications are secured in locked medication cabinet in kitchen. Toxins and chemicals are secured in laundry alcove in family room that is inaccessible to clients, where washer and dryer are located.

Staff and client records are reviewed, including Centrally Stored Medications Records and cash handling log. Rochelle Rivera is a certified ARF administrator (x 8/26) that oversees facility operations.

The following forms are requested to be completed and sent to CCLD BY 11/19/25:

Deficiency of the California Code of Regulations, Title 22, is cited on following page.