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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420689
Report Date: 10/13/2021
Date Signed: 10/13/2021 09:39:06 AM

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:OCAMPO, LETICIAFACILITY NUMBER:
013420689
ADMINISTRATOR:OCAMPO, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 355-4539
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:14CENSUS: 10DATE:
10/13/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Leticia OcampoTIME COMPLETED:
09:45 AM
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
On 10/13/21 at 8:47am, Licensing Program Analyst Briana Plumboy met with licensee Leticia Ocampo for an UNANNOUNCED POC INSPECTION. Present for this visit was assistant S1, 3 infants and 7 preschool age children.

The facility is in ratio today. LPA Plumboy cleared the deficiency which was cited on 10/6/21 for ratio.

LPA Plumboy provided Leticia Ocampo a clearance letter for the ratio citation.

There are no deficiencies cited today. 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: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
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