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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410504131
Report Date: 08/30/2024
Date Signed: 08/30/2024 01:22:13 PM

Document Has Been Signed on 08/30/2024 01:22 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:CATHOLIC CHARITIES ADULT DAY SERVICES-SAN MATEO COFACILITY NUMBER:
410504131
ADMINISTRATOR/
DIRECTOR:		CLEMENT-CIHAK, PATRICIAFACILITY TYPE:
775
ADDRESS:787 WALNUT STREETTELEPHONE:
(650) 592-9325
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 40CENSUS: 24DATE:
08/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Carmen Santoni TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On August 30, 2024, Licensing Program Analysts(LPAs) John Calandra and Kiran Jain arrived at the facility at 1:00 PM to deliver an Amended report. LPAs Calandra and Jain met with Carmen Santoni, Program Director and explained the purpose of the visit.

LPAs Calandra and Jain explained the reasoning for the Amended report to Carmen Santoni, Program Director.

An exit interview was conducted. This report was reviewed with Carmen Santoni, Program Director and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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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