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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600805
Report Date: 10/04/2024
Date Signed: 10/04/2024 04:07:13 PM

Document Has Been Signed on 10/04/2024 04:07 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:
10/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Julieta Jornales Biagi, House ManagerTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On October 4, 2024, Licensing Program Analyst(LPA) 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.

On 09/27/2024, the facility was cleared for California Code of Regulation (CCR), 87303(e)(2) Maintenance and Operation, 87555(b)(8) General Food Service Requirements, 1569.695(c) Other Provisions.

On 09/27/2024, 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,the facility was assessed for Civil Penalty in the amount of $700, $100 a day from 9/21/24 through 9/27/24.

During the visit, LPA observed that the dishwashing solution, knives, and other cleaning solutions were properly locked and inaccessible to residents in care. On 09/30/2024, Jocelyn De la Tore, Administrator provided photos and plan of correction to keep chemicals and sharps locked to LPA Jain by email. Deficiency for CCR 87309(a) Storage Space is corrected and deficiency is cleared.

No deficiencies cited during the visit. Report is reviewed with Julieta Jornales Biagi, House Manager, and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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