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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317895
Report Date: 10/20/2023
Date Signed: 10/20/2023 11:14:46 AM

Document Has Been Signed on 10/20/2023 11:14 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ESTRELLA'S CARE HOMEFACILITY NUMBER:
390317895
ADMINISTRATOR:HERMIGINIO JOSEFACILITY TYPE:
735
ADDRESS:2607 CARPENTER ROADTELEPHONE:
(209) 465-4231
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 6CENSUS: 6DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Administrator not presentTIME COMPLETED:
11:00 AM
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On 10-20-23 at 10:20am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct an annual inspection. LPA rang door bell and waiting 5 minutes for response. LPA then left message for Administrator with no response as of 11:00am. LPA observed home from window with lights off and shades drawn. As a result, this annual visit was unable to be completed today.

A copy of this report will be mailed to Licensee with request for return with signature.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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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