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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408503
Report Date: 06/04/2021
Date Signed: 06/04/2021 02:55:56 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:BOLDEN-KRAMER, RACHELFACILITY NUMBER:
073408503
ADMINISTRATOR:BOLDEN-KRAMER, RACHELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 779-2786
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:14CENSUS: 6DATE:
06/04/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rachel Bolden-KramerTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Paul Petersen conducted a case management site inspection of this facility at 12:30 PM. LPA inspected the new deck area installed at the rear of the home. The deck area is fully enclosed by safety fencing/netting and is approved to be on limits for children in care with adult supervision present at all times that area is used by children. The outdoor entry area, from the fence gate to the deck is approved to be on-limits to children in care with adult supervision present at all times children are using the area and the fence gate securely closed while children are in the area. There are no pools, hot tubs or other bodies of water and no high climbing equipment present in this area.

The above defined areas are on-limits to children in care with the above stipulations regarding adult supervision and the gate closure. The small building structure including kitchenette and bathroom which is attached to the rear deck will remain off limits to children in care pending a fire department inspection clearance.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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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