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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404256
Report Date: 11/10/2021
Date Signed: 11/10/2021 03:31:49 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:ALICEA, DEBBIEFACILITY NUMBER:
073404256
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
11/10/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Debbie Alicea TIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management inspection. Present during the inspection was the licensee, her fingerprint cleared husband, and fingerprint cleared adult children. There were no children in care during the inspection.

Licensee has requested an inspection to change the on/off limits area of the home. Licensee has applied for a large family child care home. The fire clearance has been denied as the home is not cleared for child care on the second floor. Licensee has submitted a new facility sketch and has requested the entire second floor of the home to be made off limits. Licensee requested the first floor kitchen, family room, living room, dining room, den and bathroom be changed to on limits for child care. The home was inspected and these areas are approved to be used for child care as of today, 11/10/21. The garage and back yard are to remain off limits to children. The entire second floor is placed off limits as off today.

The home has a pool and hot tub. There is a fence to prevent access to the pool and hot tub. The fence has a self closing gate that opens away from the pool.

Exit interview was conducted with Debbie Alicea.
Notice of Site was provided 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: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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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