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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201266
Report Date: 09/15/2023
Date Signed: 09/15/2023 11:17:41 AM

Document Has Been Signed on 09/15/2023 11:17 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GOLDEN STAR HOMEFACILITY NUMBER:
079201266
ADMINISTRATOR:ARNANTE, CLAUDIOFACILITY TYPE:
735
ADDRESS:1779 BILLINGS RDTELEPHONE:
(925) 349-5335
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 6CENSUS: 6DATE:
09/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Marina Suriao, Staff TIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Jill Clancy-Czuleger and Alona Gomez, conducted an un-announced Component III Training. Component III was attended by Marina Suriao (Staff)

LPA J. Clancy-Czuleger presented the training via Power Point presentation and had a discussion with applicants.

Exit interview conducted and copy of this report provided at the conclusion of the training
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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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