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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408422
Report Date: 11/19/2021
Date Signed: 11/19/2021 11:16:03 AM

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:RAMIREZ, LESLIEFACILITY NUMBER:
073408422
ADMINISTRATOR:RAMIREZ, LESLIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 301-5536
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 7DATE:
11/19/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Leslie RamirezTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Plan of Correction (POC) inspection. Present during the inspection was the licensee, her fingerprint cleared aides/adult daughters, six preschool aged children and one infant in care.

During today's inspection LPA inspected the pool fence. The fence was observed to be in compliance with title 22 regulations. The fence gates opens away from the pool and are self latching. The backyard is placed on limits for children and may be used for outdoor play effective today 11/19/21.

Deficiencies are cleared during today's inspection.
Exit interview conducted with Leslie Ramirez
Notice of Site Visit 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: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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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