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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200302
Report Date: 04/26/2023
Date Signed: 04/26/2023 05:58:02 PM


Document Has Been Signed on 04/26/2023 05:58 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:STUART HOUSE, THEFACILITY NUMBER:
079200302
ADMINISTRATOR:PAMELA GREENFACILITY TYPE:
740
ADDRESS:3067 BELFAST WAYTELEPHONE:
(510) 262-0206
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:6CENSUS: 4DATE:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:PAMELA GREEN, ADMINISTRATORTIME COMPLETED:
09:39 AM
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On 4/26/2023 at 9:28AM, Licensing Program Analyst (LPA) C. Fowler conducted an unannounced Case Management visit to retrieve documents dated 4/4/2023 that was generated in error. LPA met with administrator Pamela Green and explained the purpose of the visit.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol FowlerTELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023
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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