SHANNON ICF/DDH HOME
ICF/DD-H (Habilitative) · 6 licensed beds · South San Francisco, CA
Homes of 4–15 beds for people with developmental disabilities whose nursing needs are intermittent and predictable.
Address
SHANNON ICF/DDH HOME2 ARLINGTON DRSouth San Francisco, CA 94080 · San Mateo CountyPhone: (650) 757-7725
State penalties
1
Class 1 A
Federal surveys
20
since 2018 · 10 with deficiencies
Federal deficiencies
86
6 condition-level
Last federal survey
Jan 5, 2026
survey date
Facility details
- Facility type
- ICF/DD-H (Habilitative)
- Licensed beds
- 6
- Licensee
- FAMILY HOMES, INC. · Profit Corp
- Administrator
- YEMA, HERMIE
- CDPH facility ID
- 220000804
- License number
- 220000304
- First licensed
- August 2, 1994
- Current license
- Mar 17, 2026 to Mar 16, 2027
- CDPH district office
- San Francisco
Federal certification (CMS)
- CMS Certification Number (CCN)
- 05G819
- Status in CDPH's listing
- Licensed And Certified
- Program
- Medi-Cal (Medicaid, Title XIX)
- Participating since
- November 10, 1994
- Last certification survey
- April 10, 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 1 · LVN/LPN 0 · direct care 8 · all employees 9
State citations and penalties (CDPH)
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 APatient CareDeath-related
Citation A (HSC 1424) · Violation Jul 23, 2015 · Penalty #220014101 · Survey DHBL11
Status: Closed · Not appealed
$20,900
initially $20,000
Federal inspections (CMS-2567)
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").
· Complaint
Event TLF011 · no deficiencies cited
· Complaint
Event S49011 · no deficiencies cited
· Complaint
Event KY6011 · no deficiencies cited
· Complaint
Event T99711 · no deficiencies cited
· Focused Infection Control, Other-Fed
Event 4V9J11 · no deficiencies cited
· Complaint
Event 0I8Z11 · no deficiencies cited
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
22 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.
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (recertification): 7 deficiencies(state record)
ReportFederal survey (complaint, recertification): 8 deficiencies(state record)
ReportFederal survey (recertification): 10 deficiencies(state record)
ReportFederal survey (recertification): 4 deficiencies(state record)
ReportFederal survey (recertification): 6 deficiencies(state record)
ReportFederal survey (recertification): 4 deficiencies(state record)
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): 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.