<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211076
Report Date: 03/13/2020
Date Signed: 03/13/2020 01:52:15 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:KEEL, MESHELLEFACILITY NUMBER:
070211076
ADMINISTRATOR:KEEL, MESHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 232-8458
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:12CENSUS: 4DATE:
03/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Meshelle KeelTIME COMPLETED:
01:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced case management site inspection for this facility at 1:05 PM for the purpose of amending prior documentation. Assistant, Brenda Johnson, was present along with six children in care at the time of LPA's arrival. Licensee arrived while LPA was present and a copy of the amended report was provided for licensee.

There were no deficiencies cited during this site visit. A notice of site visit was provided and a copy of this report is to remain in the facility files for a period of 30 days.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1