<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419574
Report Date: 04/29/2022
Date Signed: 05/04/2022 04:56:47 PM


Document Has Been Signed on 05/04/2022 04:56 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/02/2022 04:34 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

NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
*THIS IS AN AMENDED DOCUMENT. LICENSEE WAS NOT AVAILABLE TO SIGN AT THIS DATE. LICENSEE'S SPOUSE SIGNED THIS DOCUMENT*

On 4/29/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Case Management inspection to verify correction of deficiencies cited on 4/1/2022. LPA was met by Licensee's 17-year old son.

Licensee's son stated that Licensee (Lynda Alcorn-Fernandez) was currently at a nearby public park. LPA spoke to Licensee over the phone and Licensee stated that she was hosting a birthday party for one of the daycare children and would arrive at approximately 4:00pm. Licensee directed LPA via phone to the location of facility files in the home and LPA reviewed facility files. Licensee arrived at the facility at 3:40pm along with six children in care (one infant, two school-aged, and three-preschool-aged).

During Required 1-Year inspection conducted on 4/1/2022 by LPA Williams, no files could be reviewed because they were in an inaccessible location at the time. Two Type B deficiencies were cited. During today's inspection, LPA reviewed the previously inaccessible facility records, including child's records and personnel records, for proper documentation. Facility records were present in the facility in an accessible location during today's visit. Deficiencies cleared.

No deficiencies were cited today. Exit interview conducted. Appeal rights and notice of site visit were given to the Licensee.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1