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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600310
Report Date: 09/13/2023
Date Signed: 09/13/2023 11:09:57 AM


Document Has Been Signed on 09/13/2023 11:09 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CELESTE CARE HOMEFACILITY NUMBER:
415600310
ADMINISTRATOR:GALANG, TERESITA M.FACILITY TYPE:
740
ADDRESS:1714 CELESTE DRIVETELEPHONE:
(650) 356-0902
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:6CENSUS: 0DATE:
09/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Necia CondeTIME COMPLETED:
11:20 AM
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On September 13, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit to confirm facility closure. LPA met with Administrator, Necia Conde and explained the purpose of the visit.

On 8/1/2023, CCL received a closure notice from the Licensee. During the visit, LPA toured the facility and grounds.

During the tour, LPA observed the kitchen, living room, dining room, 4 resident bedrooms, 2 staff rooms, 2 bathrooms, backyard, closets, and garage. No resident belongings were observed. No staff members were present. Administrator and Licensee are in the process of moving all facility furniture out of the home.

Licensee informed CCL of facility closure by letter. LPA did not observe any residents and did not observe evidence of care and supervision In the home. Administrator provided LPA the resident roster and the facilities they moved to.

CCLD will be proceeding with the closure. A forfeiture letter will be sent to licensee and the facility number 415600310 shall be closed.

This report is reviewed, and discussed with the Administrator, and a copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
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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