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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403182
Report Date: 06/20/2019
Date Signed: 06/20/2019 03:23:58 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:WIMBERLY, KATHLEENFACILITY NUMBER:
073403182
ADMINISTRATOR:WIMBERLY, KATHLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 232-6829
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 12DATE:
06/20/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Kathleen WimberlyTIME COMPLETED:
03:30 PM
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Licensing Program Analyst, LPA, Paul Petersen conducted an unannounced Plan of Correction site inspection for this facility on 06/20/19. LPA met with licensee, Kathleen Wimberly. Also present were licensee's background cleared assistant and 12 children in care consisting of three infants and nine preschool age children. The deficiency cited on 06/06/19 is now cleared and there are no remaining deficiencies to be cleared.

There were no deficiencies cited during this inspection. A notice of site visit was provided as well as a proof of correction letter. This report is to remain in the facility records for a period of three years.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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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