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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005145
Report Date: 10/18/2019
Date Signed: 10/18/2019 04:10:33 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: 7DATE:
10/18/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Julia Moran-Solis and Royal StarbirdTIME COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Van and Bashir-Tariq conducted an unannounced case management inspection and met with licensee's Aides , Julia Moran-Solis and Royal Starbird. Both helpers have cleared fingerprints. The purpose of the inspection was explained to the helpers, and it was to verify that Orlando Terrell Wiggins, S1 and S2 whose Criminal Record Clearances were denied by Caregiver Background Check Bureau (CBCB) are not present in the facility. Present there are 7 children in care, one is licensee's grandson. Licensee was not at home during the inspection but spoke with LPA Van over the phone

In today’s inspection, LPAs and licensee's aide inspected the entire facility for health and safety hazards. LPAs did not see any of the above individuals in the facility today. During the conversation with licensee over the phone, licensee stated she was no longer pursuing to employ S1, and S2. Licensee stated that after she received the case closure letters from CBCB for S1 and S2, both were let go and no longer working at her facility. In regard to Orlando Terrell Wiggins, licensee stated she had sent CBCB all necessary documentation to proof that they were legally separated. LPAs explained to licensee the exclusion of Orlando Wiggins and her responsibility. Licensee stated Orlando Wiggins does not lived at her facility. Licensee also stated that she understood that all individuals mentioned above are not associated to her facility and are not supposed to work or live in the home.

No deficiencies were cited today. This report and rights to comment were discussed with licensee. This report must be available in the facility for public review. Notice of site visit was posted.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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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