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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011441012
Report Date: 04/03/2024
Date Signed: 04/03/2024 07:07:42 PM

Document Has Been Signed on 04/03/2024 07:07 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CANOVAS HOMEFACILITY NUMBER:
011441012
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		CANOVAS, VICTORIA R.FACILITY TYPE:
735
ADDRESS:22968 MAUD AVENUETELEPHONE:
(510) 530-3037
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 6CENSUS: 4DATE:
04/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Victoria Canovas/Administrator TIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
04:00 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) Delmundo arrived unannounced to conduct a POC visit for the deficiency (section 80020(a)) cited on March 22, 2024. LPA met with staff, Jose 'Jay' Fernandez and Milagros 'Mel' Fernandez. LPA later met with Victoria Canovas, administrator.

Administrator submitted pictures on March 23. 2024 showing walls of the room were demolished.

On this day, 4/03/24, LPA inspected the sun room and observed the walls were torn down, ceiling already fixed and flooring is in the final process of being leveled. Contractor was observed present in the facility.

Exit interview conducted, and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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