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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601155
Report Date: 11/21/2024
Date Signed: 11/21/2024 01:12:10 PM

Document Has Been Signed on 11/21/2024 01:12 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: 1DATE:
11/21/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:43 AM
MET WITH:Mark CalaunanTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 11/21/24 LPA Grace Donato made an unannounced post-licensing visit to the facility. LPA met with Administrator Mark Calaunan. LPA explained the purpose of the visit.

LPA toured the facility inside and outside including all of activity rooms & kitchen. The indoor and outdoor passageways were free of obstruction. One client is currently in the facility. Carbon monoxide monitor is working properly. All fire extinguishers have been checked and current. Client bathrooms were observed to be in good repair equipped with grab bars and non-skid mats.

Resident records are updated, complete and signed. Staff records are complete, with training logs.

No deficiencies are cited at this time. Report is reviewed and a copy is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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