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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411363
Report Date: 08/30/2023
Date Signed: 08/30/2023 12:20:51 PM


Document Has Been Signed on 08/30/2023 12:20 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:BROWN, SENOVIAFACILITY NUMBER:
013411363
ADMINISTRATOR:BROWN, SENOVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 567-6188
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:12CENSUS: 6DATE:
08/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Senovia BrownTIME COMPLETED:
12:00 PM
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LPA Andrew Elliot met with Licensee Senovia Brown on 08/30/2023 at 11:45 am to follow up on deficiencies cited in a Random Annual Inspection Visit that occurred on 08/24/2023. LPA explained the purpose of the visit and was allowed entry into the facility at 11:45 am.

6 preschool aged children were present at the time of the visit in addition to the licensee. LPA observed that 5 out of 5 cited deficiencies have been cleared as per the agreed upon plan of corrections (POC)s.

LPA observed that the deficiency regarding CCR 102419(d)(1) has been resolved as per the POC. LPA observed that the deficiency regarding 102417(g)(8) has been resolved as per the POC. LPA observed that the deficiency regarding CCR 102421(b) has been resolved as per the POC. LPA observed that the deficiency regarding CCR 102419(d) as per the POC. LPA observed that the deficiency regarding CCR 102418(g).

LPA observed that all cited deficiencies have been cleared at the time of the case management visit.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Andrew ElliottTELEPHONE: (510) 363-5635
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023
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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