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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005348
Report Date: 09/05/2019
Date Signed: 09/05/2019 03:35:54 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:DE OLIVEIRA, MARIANGELAFACILITY NUMBER:
214005348
ADMINISTRATOR:DE OLIVEIRA, MARIANGELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 368-8713
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:14CENSUS: 4DATE:
09/05/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Mariangela De Oliveira TIME COMPLETED:
03:50 PM
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Licensing Program Analysts (LPAs) Van and Bashir-Tariq met with licensee, Mariangela De Oliveira, for an announced inspection of Plan of Correction (POC). The purpose of the inspection was explained and was granted entry to the home by licensee. Present, there are 4 children (all 4 children are infants) in care with licensee. Licensee is operating within ratio today.

On four previous inspections May 16, June 26, and July 23, and August 29, the facility was operating out of ratio. On August 29, 2019 inspection, this facility received a failure to correct civil penalty assessment. In today's inspection, LPAs inspected the facility for health and safety hazards to verify the correction of the previous deficiencies.

At 3:15 P.M., Children records were reviewed and confirmed that two of the children were no longer attending the day care, licensee provided the new Children's Rosters to LPA during the inspection. This clear the previous issued deficiencies.

An exit interview was conducted with licensee. A consultation provided. No deficiencies are cited today. A copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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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