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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 385600359
Report Date: 09/22/2021
Date Signed: 09/22/2021 11:08:13 AM

Document Has Been Signed on 09/22/2021 11:08 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CARLISLE, THEFACILITY NUMBER:
385600359
ADMINISTRATOR:FOX, ALANFACILITY TYPE:
740
ADDRESS:1450 POST STTELEPHONE:
(415) 929-0200
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY: 130CENSUS: 70DATE:
09/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administrator, Stephaine SchmautzTIME COMPLETED:
11:15 AM
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On 9/22/2021, Licensing Program Analyst (LPA) Murial Han conducted an unannounced Case Management visit to amend a report in reference to complaint # 14-AS-20210818082130. LPA Han met with the Administrator, Stephanie Schmautz and explained the purpose of today's visit.
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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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