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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600805
Report Date: 09/27/2024
Date Signed: 09/27/2024 01:23:49 PM

Document Has Been Signed on 09/27/2024 01:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:HEIRLOOM GARDENS OF DALY CITYFACILITY NUMBER:
415600805
ADMINISTRATOR/
DIRECTOR:		DE LA TORRE, JOCELYNFACILITY TYPE:
740
ADDRESS:75 SURREY COURTTELEPHONE:
(650) 922-1039
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 6CENSUS: 5DATE:
09/27/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Julieta Jornales Biagi, House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On September 27, 2024, at 12:30 PM Licensing Program Analysts(LPAs) Komal Charitra and Kiran Jain conducted an unannounced plan of correction (POC) visit to verify and to confirm that the facility is in compliance with the citations that were issued on 09/19/2024 during an annual inspection. LPAs met with Julieta Jornales Biagi, House Manager, and explained the purpose of the visit.

On 09/19/2024, the facility was cited for California Code of Regulation (CCR), 87303(e)(2) Maintenance and Operation, 87309(a) Storage Space, 87555(b)(8) General Food Service Requirements, 1569.695(c) Other Provisions.

During the visit, LPAs measured water temperature throughout the facility. Water temperature measured at 109.8 degrees F. Deficiency for CCR 87303(e)(2) is corrected and deficiency is cleared. Refrigerator and pantry was observed to have 2-day perishables and 7-day non-perishables, all observed to be in good quality. Deficiency for CCR 87555(b)(8) is corrected and cleared. Emergency disaster drill log was provided to LPA Jain by email on 9/25/24. Health & Safety Code 1569.695(c) was corrected and deficiency will be cleared.

Chemicals and sharps were observed to be unlocked and accessible to residents in care. Due to the citation 87309(a) Storage Space, not being corrected by 9/20/24, a civil penalty is being assessed in the amount of $100 a day from 9/21/24 through 9/27/24 and will continue to accrue until corrected. A civil penalty of $700 is provided during the visit.

Report is reviewed with Julieta Jornales Biagi, House Manager at the facility and report was reviewed with the Administrator, Jocelyn De la Tore over the phone, and a copy is provided with the civil penalty.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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