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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294170
Report Date: 12/07/2021
Date Signed: 12/07/2021 02:06:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:CASA PASTEL CARE HOMEFACILITY NUMBER:
435294170
ADMINISTRATOR:ZHAO, PING JINGFACILITY TYPE:
740
ADDRESS:13348 PASTEL LANETELEPHONE:
(650) 961-5368
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:6CENSUS: 4DATE:
12/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Becky BiTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Becky Bi.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed a visitor screening area at the entrance. LPA Marrufo observed a perishable food supply of 7 days and a non-perishable food supply of 3 days. LPA Marrufo observed enough PPE supplies for 30 days. LPA Marrufo observed 2 out of 2 resident bathrooms and observed available soap and paper towels. LPA Marrufo observed COVID-19 related signs throughout the hallways of the facility.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Becky Bi and a copy of the report was provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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