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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423032
Report Date: 04/30/2020
Date Signed: 04/30/2020 11:13:07 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:AVILA, CRISTINAFACILITY NUMBER:
013423032
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
04/30/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cristina AvilaTIME COMPLETED:
11:15 AM
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DUE TO THE COVID-19 SHELTER IN PLACE ORDER BY THE GOVERNOR OF CALIFORNIA, THIS CHANGE OF CAPACITY VISIT WAS DONE VIA TELE-VISIT THROUGH FACETIME

On 04/30/2020 at approximately 10:00 AM, Licensing Program Analyst (LPA) Elimika Woods met with Cristina Avila (VIA TELE-VISIT FACETIME CALL) for an ANNOUNCED CASE MANAGEMENT CAPACITY INCREASE INSPECTION. Present for this visit was licensee's son, S. Avilabarajas, and her school aged daughter.

The home was toured to conduct a Health and Safety Inspection. There are no changes to the home since the last inspection visit on 05/01/2018. The OFF LIMITS areas will be all of the bedrooms, and will be inaccessible by closed and/or locked doors and visual supervision.

A fire clearance for 14 was approved on 01/29/2020. LPA reviewed the application prior to this visit and the home has an approved fire clearance from the Hayward Fire Department. The facility currently plans to operate 7:00 AM until 5:00 PM., Monday through Friday

There are no deficiencies cited today. Notice of Site visit was emailed to the licensee to be posted for the next 30 days. Exit interview was conducted.

Based on the approval of the fire clearance, issuance of license is recommended for this home effective today.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2020
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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