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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011404238
Report Date: 05/23/2024
Date Signed: 05/23/2024 04:17:06 PM


Document Has Been Signed on 05/23/2024 04:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:TIA MARIA FAMILY HOMEFACILITY NUMBER:
011404238
ADMINISTRATOR:MARIA A. DE ALMEIDAFACILITY TYPE:
735
ADDRESS:28175 RUUS ROADTELEPHONE:
(510) 887-6221
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:28CENSUS: 28DATE:
05/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:David de Almeida, AdministratorTIME COMPLETED:
04:30 PM
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On 05/23/2024, at 3:25 PM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct Proof of Correction (POC) visit. LPA met with Administrator, David de Almeida and explained the purpose of the visit.

Facility has the following deficiencies that was cleared:

  • 80069(c)(1) - David phoned the facility doctor who will have the nurse come out and administer the TB tests and return within 48hrs to give the results
  • 85068.4(g) - Received Age Exception Letters for R1-R6
  • 80086 (a)(c) - Received City of Hayward Notice of Violation
  • 80024 - David will send self-certification to CCLD 05/23/24

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024
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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