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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000305
Report Date: 10/26/2022
Date Signed: 10/26/2022 02:45:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/26/2022 02:45 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KEMEL, LARISAFACILITY NUMBER:
384000305
ADMINISTRATOR:KEMEL, LARISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 751-1580
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:12CENSUS: 0DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Adam Eisendrath (new owner)TIME COMPLETED:
02:45 PM
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 Licensing Program Analyst (LP:A) conducted an unannounced annual inspection today. LPA met with a new owner of the house, Adam Eisendrath. Per Adam, he bought the house in September 2020 from the licensee, Larisa Kemel. He said Larisa moved to Danville after she sold the property to him, but he doesn't know her current address. LPA will close the facility in the system.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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