Senior Care Records.

Facility Evaluation Report

Shoreview Home, San Mateo09/20/2023Licence 411408916

Capacity6
Census6
Date signed09/20/2023 04:14:40 PM
The inspector’s account

LPA Jeung followed up on citations issued on 8/31/23 and 7/24/23--for which corrections had not been submitted by due dates--and civil penalty assessments issued on 9/11/23:

Civil penalty of $500 was issued to assess $100/day x 5 days.

Criminal record clearance for staff AM is not maintained according to Dept. records and plan or proof of corrections was not received by due date 9/1/23 to adequately correct this deficiency.

Civil penalty of $300 was issu ed to assess $100/day x 3 days, 9/8 - 9/10/2023. As per Civil Penalty Assessment form LIC 421FC, civil penalty of $100 per violation per day shall be assessed until the violation is corrected.

Health screening and/or TB test results for staff AM is now maintained and copies are provided today. Plan or proof of corrections was not received by due date 9/7/23.

Plan or proof of corrections was received in regional office on 9/14/23. However, LPA was not in receipt of proof of correction until today, when clerical staff confirmed receipt.

Staff AM has criminal record clearance as of 9/13/23 and health screening for staff AM was faxed to CCLD on 9/14/23.

Civil penalty of $200 is assessed for period 9/11 to 9/13/23, which represents $100/day x 3 days.

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