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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417512
Report Date: 04/22/2020
Date Signed: 04/22/2020 02:08:08 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:GARCIA, MARIA TERESITAFACILITY NUMBER:
013417512
ADMINISTRATOR:GARCIA, MARIA TERESITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 487-3251
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 2DATE:
04/22/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Maria Teresita GarciaTIME COMPLETED:
02:15 PM
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On 04/22/20 at 1:40pm, Licensing Program Analyst (LPA) B.Plumboy conduct an Announced Case Management virtual Tele Visit inspection. LPA Plumboy and Licensee Maria Teresita Garcia conducted a Zoom Meeting call. Licensee walked through her backyard and toured her backyard by video with LPA Plumboy. Present during today's visit was the Licensee fingerprint cleared spouse Tomas Garcia, adult son Mark Thomas Garcia, and 2 day care children (2 preschoolers). This facility currently operates from 7:00am until 6:00pm.

The home is two stories. The ON LIMIT AREAS are the entire first level of the home except the laundry room and garage. The OFF LIMIT AREAS are the laundry room, garage, and entire second level of the home which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the living room. The BACKYARD play area is completely fenced and as of 04/22/20 is included as an ON LIMIT area.

This report shall remain on file for 3 years. A notice of site visit was emailed 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: 04/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2020
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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