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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603625
Report Date: 06/21/2024
Date Signed: 06/21/2024 04:54:39 PM


Document Has Been Signed on 06/21/2024 04:54 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:STELLAR CAREFACILITY NUMBER:
374603625
ADMINISTRATOR:LINDA CHOFACILITY TYPE:
740
ADDRESS:4518 54TH STREETTELEPHONE:
(619) 287-2920
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:120CENSUS: 92DATE:
06/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Administrator Brandon ChoTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an case management visit due to a request to increase the facility waiver capacity. LPA was greeted by, identified themselves to, and discussed the purpose of the visit with Administrator Brandon Cho regarding an increase in capacity for the hospice waiver on file.

Information and guidance was provided to Administrator Cho including CCLD State regulation 87632 Hospice Care waiver and CCLD State regulation 87633 Hospice Care of Terminally Ill resident's.

During today’s visit, LPA and toured the facility and observed a client in care. No immediate health and/or safety concerns were observed.

An exit interview was conducted with Director Cho, to whom a copy of this report and the Licensee Rights (LIC9058 01/16) were provided at the end of the visit.

SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy RodgersTELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2024
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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