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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700783
Report Date:
04/19/2021
Date Signed:
04/19/2021 02:05:57 PM
Document Has Been Signed on
04/19/2021 02:05 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
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
7117 MAIN, LLC
FACILITY NUMBER:
342700783
ADMINISTRATOR:
GLADYS GASTA
FACILITY TYPE:
740
ADDRESS:
7117 MAIN AVE
TELEPHONE:
(707) 592-4004
CITY:
ORANGEVALE
STATE:
CA
ZIP CODE:
95662
CAPACITY:
6
CENSUS:
6
DATE:
04/19/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:45 AM
MET WITH:
Gladys Gasta, Administrator
TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Bethany Huusfeldt and Michael Hood arrived unannounced to facility to conduct a case management visit. LPA's met with Administrator Gladys Gasta during today's inspection.
LPA's arrived to follow-up on a incident regarding suspected financial abuse. LPA's interviewed all clients in care and staff at the facility.
No deficiencies were cited during today's visit. Exit interview conducted and copy of report emailed to administrator.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Bethany Huusfeldt
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/19/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/19/2021
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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