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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010216558
Report Date: 01/08/2020
Date Signed: 01/08/2020 04:26:33 PM

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 1102
OAKLAND, CA 94612
FACILITY NAME:KIDS CARE PLUS - CHABOTFACILITY NUMBER:
010216558
ADMINISTRATOR:THOMAS, RALPHFACILITY TYPE:
840
ADDRESS:3432 CHRISTENSEN LANETELEPHONE:
(510) 538-0461
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:60CENSUS: 28DATE:
01/08/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Ralph ThomasTIME COMPLETED:
04:45 PM
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On 01/08/20, Licensing Program Analyst (LPA) Briana Plumboy met with Director Ralph Thomas for an unannounced Case Management inspection as a result of an unusual incident which was reported by the center. Present for the inspection was 3 fingerprint clear and associated staff as well as 28 school age children. The center and was toured. An interview was conducted.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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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