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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601163
Report Date: 04/24/2024
Date Signed: 04/24/2024 09:23:24 AM

Document Has Been Signed on 04/24/2024 09:23 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SAINT JARIELLE RESIDENTIAL CARE 2FACILITY NUMBER:
415601163
ADMINISTRATOR/
DIRECTOR:
UY, NANCYFACILITY TYPE:
740
ADDRESS:768 LUNDY WAYTELEPHONE:
(650) 557-1227
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 6CENSUS: 4DATE:
04/24/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Jacquelyn Melosantos TIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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On April 24, 2024, at 8:40 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unannounced follow up pre-licensing visit. LPA Calandra met with Jacquelyn Melosantos, and explained the purpose of his visit.

On 3/19/2024, LPA Calandra conducted the initial pre-licensing visit and asked the applicant to address the following:

-Ensure water temperature is lowered to between 105 and 120 degrees Fahrenheit
-Remove hoist and other items on side of house
-Remove nails from the backyard deck
-Remove Aquarium in front of house
-Ensure that all screens are in good repair
-Ensure each bedroom has a chair and sufficient lighting
-Ensure Carbon Monoxide detector is functioning

On 4/22/2024, after the visit, Nancy Uy, Applicant notified LPA Calandra of the above being resolved.

During the visit, LPA Calandra checked the hot water temperature which was measured at 105.7 degrees Fahrenheit. LPA Calandra also observed that the nails in the backyard, hoist, Aquarium, and other items have been removed by the Applicant. Each bedroom as of 4/24/2024 has sufficient light and chairs and the Carbon Monoxide detector is functioning.

As a result of today's inspection, most of the areas of concern from the initial inspection have been resolved. LPA Calandra will return to follow up on the screens in the backyard that are not in good repair as of 4/24/2024.

No deficiencies were cited during today's visit. This report was reviewed with Jacquelyn Melosantos, and a copy of the report left at the facility.
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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