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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408625
Report Date: 01/25/2022
Date Signed: 01/25/2022 09:24:28 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:SILVA, CHAMANIFACILITY NUMBER:
073408625
ADMINISTRATOR:SILVA, CHAMANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 804-6700
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:14CENSUS: 4DATE:
01/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Chamani SilvaTIME COMPLETED:
09:35 AM
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On January 25, 2022 at 8:45am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced to conduct a case management inspection. LPA met with licensee Chamani Silva. Present were four preschool age children.

During an inspection on 12/10/2021, the backyard was placed OFF-LIMIT due to the presence of a fish pond without a fence. The purpose of today's inspection is to ensure the backyard is safe and ready to be placed back ON-LIMIT. LPA observed today that licensee has installed a 5 foot high fence surrounding the fish pond. As of today, the backyard is approved for ON-LIMIT use.

No deficiencies are cited today. Exit interview conducted with licensee Chamani Silva and copy of report provided. A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
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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