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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005145
Report Date: 06/26/2019
Date Signed: 06/26/2019 12:57:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:WIGGINS, LA TANYAFACILITY NUMBER:
214005145
ADMINISTRATOR:WIGGINS, LA TANYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 879-1304
CITY:MARIN CITYSTATE: CAZIP CODE:
94965
CAPACITY:14CENSUS: 6DATE:
06/26/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:La Tanya WigginsTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Van conducted a POC (Plan of Corrections) inspection and met with licensee La Tanya Wiggins and her 17 years old helper. Present in the facility is 6 children (2 are infants and 4 are preschool age).

The POC were related to the deficiencies cited on 5/31/2019. On that day licensee did not have her immunization, multiple children's records were missing immunization on file and fire drill was not logged. LPA and licensee inspected the day care areas. LPA reviewed children's files. Licensee has her immunization completed, all children immunization are on file, and a log of fire drill is documented.

Deficiency issued on 05/31/19 is now cleared.

***No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3***

Report was reviewed and provided to licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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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