<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408344
Report Date: 07/05/2023
Date Signed: 07/05/2023 12:45:37 PM


Document Has Been Signed on 07/05/2023 12:45 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:GALVEZ, NYISHAFACILITY NUMBER:
073408344
ADMINISTRATOR:GALVEZ, NYISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 417-2460
CITY:RICHMONDSTATE: CAZIP CODE:
94803
CAPACITY:14CENSUS: 0DATE:
07/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:GALVEZ, NYISHATIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
THIS REPORT IS AN AMENDED REPORT FROM ORIGINAL REPORT DATED JUNE 14, 2023.

On July 5, 2023 at 11:05 AM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced case management inspection for an Unusual incident report that was reported on May 2, 2023. LPA met with licensee Galvez, Nyisha there were no children present today during inspection due to being closed for the holiday. Licensee has verified she has a total of (24) families enrolled at her facility including drop ins, (that she gets twice a year) and part time that do not come all at the same time.

There were no deficiencies during today’s visit, Exit interview and report reviewed with Licensee Galvez, Nyisha

Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1