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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700305
Report Date: 11/13/2020
Date Signed: 11/13/2020 04:14:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MENESES MILLAN, CLAUDIAFACILITY NUMBER:
435700305
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
11/13/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:StaffTIME COMPLETED:
03:00 PM
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On 11/13/20, at approximately 1:30 PM, Licensing Program Analyst (LPA) James Sampair met with two Teachers with the permission of Claudia Meneses Millan to meet with the LPA via FaceTime for an ANNOUNCED CASE MANAGEMENT - CAPACITY INCREASE INSPECTION.

The prerequisite fire clearance for 14 had been approved on 10/14/20 by the Palo Alto Fire Department. The LPA conducted his Health and Safety Inspection by touring the facility inside and outside in partnership with the Teachers who directed the camera and answered his questions. There were no significant changes to the home since the last inspection on 08/21/19. The Licensee plans to operate the facility Monday through Friday from 8:00 AM to 6:00 PM.

The OFF LIMIT areas are the office, back bedroom/bathroom, and kitchen, which have been made inaccessible with safety gates, closed and/or locked doors and ongoing visual supervision.

There were no deficiencies cited today. An Exit Interview was conducted and Notice of Site visit was emailed to the licensee that will be followed up with a hard copy, which will be posted for the next 30 days.

Based on the Fire Department's approval and this inspection, issuance of a license with the increased capacity of 14 is recommended for this facility effective today.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
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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