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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418519
Report Date: 02/10/2020
Date Signed: 02/10/2020 02:32:53 PM

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 1102
OAKLAND, CA 94612
FACILITY NAME:PALASTI, ADRIENNE EFACILITY NUMBER:
013418519
ADMINISTRATOR:PALASTI, ADRIENNE EFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 427-2351
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:14CENSUS: 12DATE:
02/10/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Adrienne PalastiTIME COMPLETED:
02:40 PM
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On 02/10/20, Licensing Program Analyst Briana Plumboy met with licensee Adrienne Palasti for an UNANNOUNCED POC INSPECTION. Present for this visit was licensees fingerprint clear assistant Marilene Saia, 4 infants, and 8 preschool age children. The home was toured.

The licensee is in ratio today. A POC letter was issued for the citation cited on 02/06/2020. 14 children's records were reviewed with 14 Lic.9224s in file.

There are no deficiencies cited during today's inspection. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
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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