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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002736
Report Date: 11/08/2021
Date Signed: 11/08/2021 01:56:49 PM

Document Has Been Signed on 11/08/2021 01:56 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PORTNOVA, STELLAFACILITY NUMBER:
384002736
ADMINISTRATOR:PORTNOVA, STELLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 999-1670
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:TIME COMPLETED:
02:00 PM
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On November 8, 2021, Licensing Program Analyst (LPA), Van, conducted a case management visit at the Licensee home. The purpose of the visit was regarding an outstanding annual fee, an expired Inactive License status, and inquiring if the Licensee was still interested in maintaining her License. On 9/13/2021 and 10/14/21, certified letters were sent to the Licensee's home to contact her about her license status and non-payment of the annual fee. Furthermore, phone calls have been made on numerous occasions, and voice mails were left on Licensee's facility phone, and there was no response from the Licensee.

In today's case management visit, LPA rang the doorbell multiple times, and no one was answering the door. A call was made to the Licensee's facility phone listed on the facility profile, and the Licensee picked up the phone. LPA informed the Licensee that LPA was at the front door. LPA asked the Licensee if she could open the door or come to the door and talk to LPA. The Licensee responded with, why? And a few seconds later hung up. A second phone call was made, and the Licensee did not pick up the phone and went to voicemail.

Forfeiture of the License will be sent to the Licensee.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2021
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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