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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001308
Report Date: 12/16/2019
Date Signed: 12/16/2019 03:06:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:GRAVES, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483001308
ADMINISTRATOR:GRAVES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 557-7473
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:12CENSUS: 6DATE:
12/16/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Maria GravesTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Melchisedeck Augustin made an unannounced case management inspection to follow up on an Advisory Note Technical Violation that was issued on 12/09/19. On 12/09/19, LPA observed a segment of the upper level deck post was not sturdy and the Licensee had agreed to repair the deck post by 12/16/19. During today's inspection, LPA met with Licensee Maria Graves and LPA discussed the purpose of the inspection with the Licensee. LPA toured the facility upper level outdoor wooden deck post. The deck was sturdy and did not shake. LPA consulted on CCR 102417(g) and the Licensee is aware that the home shall be free from defects or conditions which might endanger a child. This report was reviewed and discussed with the Licensee.

Notice of Site Visit shall be posted for 30 days from today's inspection. There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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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