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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601163
Report Date: 06/14/2024
Date Signed: 06/14/2024 09:38:14 AM

Document Has Been Signed on 06/14/2024 09:38 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: 5DATE:
06/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Elizabeth Huliganga, CaregiverTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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On June 14, 2024, at 9:00 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the pre-licensing. LPA Calandra was greeted by Elizabeth Huliganga, Caretaker and explained the purpose of the visit. LPA Calandra asked Elizabeth Huliganga, Caretaker to call Nancy Uy and Jacqueline Melosantos, the applicants to see if they could join the visit but neither could.

This inspection was to follow up on the corrections that needed to be made per initial pre-licensing inspection conducted on March 19, 2024.

LPA toured portions of the facility to inspect the areas that required corrections.

LPA observed and verified the corrections have been made as follows:
- Screens in the backyard have been fixed/replaced

As a result of inspection today, the pre-licensing area of concerns have been resolved. Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau.

No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Elizabeth Huliganga, Caretaker and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2024
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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