<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001615
Report Date: 02/08/2022
Date Signed: 02/08/2022 12:53:31 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:AMAYA, JOVANNYA L.FACILITY NUMBER:
384001615
ADMINISTRATOR:AMAYA, JOVANNYA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 334-9524
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:14CENSUS: 9DATE:
02/08/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Amaya JovannyaTIME COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst, LPA Yee conducted a case management inspection today. Present at the facility are the licensee, Amaya, her mom, her sister, and 9 children. The facility requested to add additional room for the daycare. Today, LPA inspected the room for health and safety hazards. No visible hazards were observed. The front room was inspected and approved.

Day-care areas: Living room, dining room, front room, bathroom, and back yard. The remaining of the house are off limits. The facility personnel summary report was reviewed with the licensee, she said it's correct. Current residents at the facility are Jovannya, Jovannya's boyfriend, her mother, her sister, her 10 yr old daughter, and her niece. The facility summary personnel was reviewed with Amaya and she said it's current. Safe Sleep was explained. LIC9227 was provided.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1