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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600805
Report Date: 03/19/2025
Date Signed: 03/19/2025 10:29:13 AM

Document Has Been Signed on 03/19/2025 10:29 AM - 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: 0DATE:
03/19/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Administrator, Jocelyn De La TorreTIME VISIT/
INSPECTION COMPLETED:
10:38 AM
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On March 19, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit in regards to an incident that occurred on 3/16/25. LPA met with Administrator, Jocelyn De La Torre and explained the purpose of the visit. Daly City Fire Investigator also joined for the visit.

The administrator reported on March 16, 2025, at around 1:20am, there was smoke observed on the roof of the house. Police, Fire Department and Paramedics arrived to the facility and all 5 residents and caregivers were immediately evacuated. No injuries were noted during the evacuation. Residents were relocated to new facilities at around 2:30am. Medications and personal belongings were provided to the residents and the new facilities they were relocated to. All required parties were notified.

During the visit, LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen with the administrator and fire investigators. No residents or staff members were observed during the visit.

Daly City Fire Department will provide a fire investigation report to CCLD.

LPA requested a plan from the administrator, including by not limited to: time-frame for restoration, communicating with the fire department for a new fire clearance, future operating plans, etc.

No citations are issued during the visit. LPA reviewed report with the administrator and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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