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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600076
Report Date: 03/06/2024
Date Signed: 03/06/2024 02:42:42 PM


Document Has Been Signed on 03/06/2024 02:42 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 BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:STELLA'S CARE HOME IFACILITY NUMBER:
385600076
ADMINISTRATOR:MARGIE VALERIAFACILITY TYPE:
740
ADDRESS:616 39TH AVENUETELEPHONE:
(415) 752-8652
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:12CENSUS: 10DATE:
03/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Stella Chang, LicenseeTIME COMPLETED:
02:45 PM
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On March 6, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 2:30 PM to conduct a Case Management visit to deliver an Amended report from LPA Calandra's previous Annual 1-year required visit on February 21, 2024. LPA Calandra was greeted by Stella Chang, Licensee and explained the purpose of his visit.

This report was reviewed with Licensee, Stella Chang, and a copy of the report and the Amended report left at the facility.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
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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