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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004256
Report Date: 12/17/2019
Date Signed: 12/17/2019 11:51:13 AM

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:MELAZZO, NEIDEMAR A.FACILITY NUMBER:
414004256
ADMINISTRATOR:MELAZZO, NEIDEMAR A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 685-8270
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:14CENSUS: 7DATE:
12/17/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Neidemar A. MelazzoTIME COMPLETED:
12:05 PM
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Licensing Program Analysts (LPA), Luis J. Gomez met with Licensee, Neidemar Melazzo. Purpose of the inspection was explained and was for a Plan of Corrections (POC). Present in the facility is the licensee and helper caring for 7 children (3 infant and 4 PreK). Licensee is within capacity limits of a Large License. LPA inspected home with licensee for health and safety hazards.

On 11/25/2019, Licensee dis-enrolled infant child in her program. Proof of correction was received by the licensing office. LPA Gomez reminded licensee to visibly post, Type A deficiency and Notice of Site Visit from previous inspection next to the License. LPA reviewed children’s files and reviewed LIC 9224 (Acknowledgment of Receipt of Licensing Reports) signed by Guardians.

Deficiency issued on 11/22/2019, have been cleared. 'Cleared POC Letter' was given to Licensee.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1

This report and rights to comment and appeal were discussed with Licensee. This report must be kept in the facility available for public review. Notice of site visit was observed being posted.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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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