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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070206884
Report Date: 05/15/2019
Date Signed: 05/15/2019 04:21:51 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LARSON'S CHILDREN CENTERFACILITY NUMBER:
070206884
ADMINISTRATOR:STEPHANIE VIERRAFACILITY TYPE:
850
ADDRESS:920 DIABLO ROADTELEPHONE:
(925) 837-4238
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:45CENSUS: 26DATE:
05/15/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Isabella ReyburnTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Case Management inspection. There were 4 staff and 26 children present during the inspection. LPA met with the lead teacher Isabella Reyburn. The director had left for the day prior to LPA's arrival.

Community Care Licensing (CCL) has received a Conditional Exemption Approval for S1 from the Caregiver Background Check Bureau (CBCB) The following are the conditions of the exemption approval:

1. The individual does not transport clients.

2. The individual does not violate any licensing laws or regulations.

3. The individual does not engage in conduct that indicates that he/she may pose a risk to the health and safety of any individual who is or may be a client.

4. The individual does not fail to disclose a conviction even if it occurred before the exception was granted.

5. The individual is not convicted of a subsequent crime.

LPA spoke to Director Stephanie Vierra on the telephone. Director is aware of the conditional exemption approval for S1 and shall comply with the conditions.
Exit interview conducted with Isabella Reyburn. Appeal Rights were provided.
Notice of Site Visit was provided at time of inspection, and must be posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
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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