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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403183
Report Date: 11/27/2023
Date Signed: 11/27/2023 04:19:50 PM


Document Has Been Signed on 11/27/2023 04:19 PM - It Cannot Be Edited

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:PEREIRA, TATIANAFACILITY NUMBER:
073403183
ADMINISTRATOR:PEREIRA, TATIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 215-0683
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 3DATE:
11/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Tatiana PereiraTIME COMPLETED:
04:45 PM
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On 11/27/23 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy conducted an unannounced Case Management inspection and met with Licensee, Tatiana Pereira.

Licensee wants to add the Master Bedroom located on the second level for day care use (additional nap room). LPAs conducted an inspection of the room and approved it for use. She was reminded that all dangerous items including but not limited to poisons, medications, cleaning compounds, sharp objects must be stored inaccessible to children.
Report was reviewed with Licensee, Tatiana Pereira. Notice of Site Visit was provided.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
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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