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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403767
Report Date: 05/20/2019
Date Signed: 05/20/2019 03:50:38 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:SANDOVAL, LYDIAFACILITY NUMBER:
073403767
ADMINISTRATOR:SANDOVAL, LYDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 565-2021
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:14CENSUS: 9DATE:
05/20/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lydia SandovalTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Belinda Devall arrived at 3:00 P.M. and met with licensee Lydia Sandoval for the purpose of an UNANNOUNCED CASE MANAGEMENT INSPECTION. Present for this inspection was a fingerprint cleared assistant, three preschoolers and six school age children.

Licensee wants to place a bedroom ON LIMITS which was previously OFF LIMITS. LPA inspected the bedroom. The bedroom to the right of the bathroom is neat and clean with age appropriate toys that appear to be clean.

The ON LIMIT AREAS ARE : the family room, kitchen, 2 bedroom in the hallway, bathroom and backyard. OFF LIMIT AREAS: the living room, garage & 1 bedrooms, which will be inaccessible by barrier gate; closed and/or locked doors and visual supervision.

There were no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Belinda DeVallTELEPHONE: (510) 725-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
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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