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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601155
Report Date: 08/15/2024
Date Signed: 08/15/2024 09:09:00 PM

Document Has Been Signed on 08/15/2024 09:09 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 DAY PROGRAM - SAN MATEO LLCFACILITY NUMBER:
415601155
ADMINISTRATOR/
DIRECTOR:		CALAUNAN, MARKFACILITY TYPE:
775
ADDRESS:120 W HARRIS AVETELEPHONE:
(408) 644-5613
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 30CENSUS: 0DATE:
08/15/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Mark CalaunanTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 8/15/2024, Licensing Program Analyst (LPA) Grace Donato conducted an announced Pre-Licensing Inspection visit. LPA met with Administrator, Mark Calaunan.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA observed the indoor and the outdoor passageways are free of obstruction. This is a single level facility with 2 main activity rooms and two bathrooms. All rooms are observed with required furniture and lighting, bathrooms to be odor-free and in good repair.

Activity rooms are observed to be comfortable, spacious and free from any tripping hazards. Facility lighting is sufficient for comfort and safety. LPA toured the kitchen area and observed it to be clean and in good repair. Facility refrigerator temperatures are within regulatory standards. First aid kit is observed as in place and new. Chemicals and toxins were observed to be in a closet. It is observed as locked and inaccessible to clients.

All fire prevention systems such as sprinklers, smoke detectors, carbon monoxide detectors, fire extinguishers, and fire control panel have been inspected in place.

Component III is also conducted on this day.

Facility is clean and in good repair based on observations made today. Facility is in compliance with Title 22 regulations. No citations are issued.

A copy of report is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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