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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201451
Report Date: 01/10/2025
Date Signed: 01/10/2025 04:59:02 PM

Document Has Been Signed on 01/10/2025 04:59 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 HOME 2FACILITY NUMBER:
019201451
ADMINISTRATOR/
DIRECTOR:		ESCUETA,MILANETTEFACILITY TYPE:
740
ADDRESS:1889 WEST STREETTELEPHONE:
(510) 940-8652
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY: 6CENSUS: 5DATE:
01/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:55 PM
MET WITH:Milanette Escueta/Applicant-Administrator
and Adrian Escueta/Assistant Administrator 		TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Alicia Delmundo conducted an announced Component III Training via Teams Meeting. Component III was attended by Milanette Escueta, applicant-administrator, and Adrian Escueta, assistant administrator (AADM).

LPA Delmundo presented the training via Power Point presentation, and had a discussion with the applicant and AADM.

Exit interview conducted and copy of this report provided at the conclusion of the training.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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