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ICF/DD-H (Habilitative)License activeMedi-Cal certified

SOUTH GRANT ICF/DD-H

ICF/DD-H (Habilitative) · 6 licensed beds · San Mateo, CA

Homes of 4–15 beds for people with developmental disabilities whose nursing needs are intermittent and predictable.

Address

SOUTH GRANT ICF/DD-H1618 S GRANT STSan Mateo, CA 94402 · San Mateo County

Phone: (650) 520-5546

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-H (Habilitative)
Licensed beds
6
Licensee
BAY HORIZON, INC. · Profit Corp
Administrator
BARANGAN, LOUIE
CDPH facility ID
220000527
License number
220000232
First licensed
October 6, 1988
Current license
Nov 7, 2025 to Nov 6, 2026
CDPH district office
San Francisco

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G086
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
December 30, 1996
Last certification survey
May 8, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (proprietary)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.25 · LVN/LPN 0 · direct care 8.5 · all employees 8.75

State citations and penalties (CDPH)

1 penalty, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BPatient Rights

    Citation B (HSC 1424) · Violation Jul 18, 2009 · Penalty #220006480 · Survey T6KZ11

    Status: Closed · Not appealed

    $700

Federal inspections (CMS-2567)

16 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Recertification

    Event ICY721 · 8 deficiencies

    Official 2567 ↗
  2. · Recertification

    Event ICY711 · 3 deficiencies

    Official 2567 ↗
  3. · Recertification

    Event WE0V21 · 7 deficiencies

    Official 2567 ↗
  4. · Complaint, Recertification

    Event WE0V11 · 3 deficiencies

    Official 2567 ↗
  5. · Complaint

    Event K8F611 · no deficiencies cited

    Official 2567 ↗
  6. · Recertification

    Event AJHY21 · 3 deficiencies

    Official 2567 ↗
  7. · Recertification

    Event AJHY11 · 2 deficiencies

    Official 2567 ↗
  8. · Complaint

    Event SRTL11 · no deficiencies cited

    Official 2567 ↗
  9. · Complaint

    Event 31NC11 · no deficiencies cited

    Official 2567 ↗
  10. · Focused Infection Control, Other-Fed

    Event U34Z11 · no deficiencies cited

    Official 2567 ↗
  11. · Recertification

    Event F63W21 · 8 deficiencies

    Official 2567 ↗
  12. · Recertification

    Event F63W11 · 6 deficiencies (1 condition-level)

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

18 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (recertification): 8 deficiencies(state record)

  2. ReportFederal survey (recertification): 3 deficiencies(state record)

  3. ReportFederal survey (recertification): 7 deficiencies(state record)

  4. ReportFederal survey (complaint, recertification): 3 deficiencies(state record)

  5. ReportFederal survey (complaint): no deficiencies(state record)

  6. ReportFederal survey (recertification): 3 deficiencies(state record)

  7. ReportFederal survey (recertification): 2 deficiencies(state record)

  8. ReportFederal survey (complaint): no deficiencies(state record)

  9. ReportFederal survey (complaint): no deficiencies(state record)

  10. ReportFederal survey (focused infection control, other-fed): no deficiencies(state record)

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.