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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211076
Report Date: 09/29/2023
Date Signed: 09/29/2023 12:26:56 PM


Document Has Been Signed on 09/29/2023 12:26 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, 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: 0DATE:
09/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:TIME COMPLETED:
12:34 PM
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On September 29, 2023 at 11:49am Licensing Program Analyst (LPA) Indira Loza arrived at the facility to deliver an amended report dated on August 10, 2023. LPA toured the facility for a health and safety inspection, there were no children present during today's visit.

Exit interview conducted with Licensee Meshelle Keel.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2023
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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