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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200025
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:30:41 PM

Document Has Been Signed on 09/30/2024 02:30 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:ESCUETA CARE HOMEFACILITY NUMBER:
019200025
ADMINISTRATOR/
DIRECTOR:		ADRIAN CARLO ESCUETAFACILITY TYPE:
735
ADDRESS:1873 WEST STREETTELEPHONE:
(510) 397-0354
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 6CENSUS: 5DATE:
09/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Adrian Escueta/Administrator TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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While at the facility for other reason, Licensing Program Analyst (LPA) Delmundo learned from Adrian Escueta, administrator (ADM), that he needs to complete the required 80 hours to be re-certified and that he has not completed the requirements. ADM indicated that Milanette Escueta, licensee, is the acting administrator.

LPA cited the facility on 11/16/23 and licensee submitted the signed letter regarding the change of administrator from Adrian Escueta to Milanette Escueta, however, copy of current certificate was not provided.

On this day, 9/30/24, LPA obtained a copy of Milanette Escueta's current administrator certificate (certificate # 6005224735; expiration: 6/22/25).

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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