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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405064
Report Date: 10/11/2023
Date Signed: 10/11/2023 10:11:28 AM


Document Has Been Signed on 10/11/2023 10:11 AM - 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:VILLANEDA, MARIAFACILITY NUMBER:
073405064
ADMINISTRATOR:VILLANEDA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 223-2747
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:14CENSUS: 7DATE:
10/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:VILLANEDA, MARIATIME COMPLETED:
11:00 AM
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On October 11, 2023 at 9:00AM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced Case Management to Amend original LIC 9099 complaint findings dated October 3, 2023.
LPA met with Licensee Villaneda, Maria present during the inspection were (1) staff,(1) infant and (6) preschool children.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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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