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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700783
Report Date: 04/08/2021
Date Signed: 04/08/2021 04:36:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:7117 MAIN, LLCFACILITY NUMBER:
342700783
ADMINISTRATOR:GLADYS GASTAFACILITY TYPE:
740
ADDRESS:7117 MAIN AVETELEPHONE:
(707) 592-4004
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
04/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Gladys Gasta, administrator TIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Wolter and Leitzell arrived at the facility unannounced on 04/08/2021 to conduct a case management visit. LPAs were cleared to conduct field visits prior to inspection, wore proper PPE, and were screened by the facility upon arrival. LPAs met with Gladys Gasta during today's visit.

LPAs conducted a brief tour of the facility and inspected food supply. Food supply was found to be adequate for 2-day perishable and 7-day non-perishable.

No deficiencies were cited during today's visit. Exit interview conducted and copy of report emailed to licensee due to COVID-19 and precautionary measures.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Danyle WolterTELEPHONE: (916) 708-5307
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
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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