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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423622
Report Date: 02/19/2021
Date Signed: 02/19/2021 09:02:39 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:DIOUF, NDEYEFACILITY NUMBER:
013423622
ADMINISTRATOR:DIOUF, NDEYEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 812-0783
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:14CENSUS: 0DATE:
02/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Ndeye DioufTIME COMPLETED:
09:10 AM
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On 2/19/21 at 8am, Licensing Program Manager (LPM) Loretta Dyson arrived at the home for an announced prelicensing inspection. A virtual inspection was initially completed on 2/16/21, when it was discovered that there was a body of water directly behind the home. LPM arrived today to verify if the body of water is inaccessible to children, and if the required fencing is available. LPM met with the applicant, Ndeye Diouf, and there was no one else present. LPM measured the fence that is erected on the cement wall that extends the length of the yard to the steps leading to the dock area. The height of the wall with the fence erected on top is over 5 feet. The 5 steps that lead from the backyard to the dock area on the water does not have a 5-foot-high fence surrounding, but has a gate blocking access to the steps. This gate is 3 feet high. The applicant advised that she plans to place some tall plants in front of this area, and behind the gate, to prevent access by children. LPM advised that the information obtained would be discussed with the regional manager and the home would not be licensed until a decision is made. LPM did not inspect any other areas, as there were no concerns noted during the virtual inspection. This report will remain on file for three years. An exit interview was conducted.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021
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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