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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421935
Report Date: 12/11/2020
Date Signed: 12/11/2020 12:11:38 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:WILSON, DANAFACILITY NUMBER:
013421935
ADMINISTRATOR:WILSON, DANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 321-1232
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 7DATE:
12/11/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Dana WilsonTIME COMPLETED:
12:15 PM
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On December 11, 2020 at approximately 10:41AM Licensing Program Analyst (LPA) Russ Haderer, met with Licensee Dana Wilson, to conduct an Unannounced Case Management site inspection. The purpose of the inspection was to confirm the Licensee completed all the Technical Advisory suggestions (LPA) Haderer made during the prior site inspection made on October 23, 2020.

LPA toured the day-care facility and reviewed all Advisory Technical Assistance / violations.

· Licensee completed Mandated Reporter training (AB1207) on 11/5/2020


· Assistant completed Mandated Reporter training (AB1207) on 11/10/2020
· Licensee & Assistance both completed CPR/First Aid training on 11/3/2020
· Licensee has obtained an brand new / fully charged 2-A-10-BC Fire Extinguisher
· Licensee has brand new (& tested) smoke alarm and carbon monoxide detector
· Licensee is maintaining a current facility roster

Based on (LPA’s) observation today, licensee day-care facility is now in compliance with the title 22 regulation and Health & Safety codes.

Licensee was reminded CPR/First Aid and the Mandated Reporter training is to be renewed every two years.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2020
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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