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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416161
Report Date: 05/23/2023
Date Signed: 05/23/2023 10:33:31 AM

Document Has Been Signed on 05/23/2023 10:33 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MARTINEZ, MARIA LUISAFACILITY NUMBER:
013416161
ADMINISTRATOR:MARTINEZ, MARIA LUISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 470-3205
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria L. MartinezTIME COMPLETED:
10:45 AM
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On Tuesday May 23, 2023 at 10:00 AM.,LPA Woods conducted a Plan of Correction (POC) visit and met with the licensee and performed a physical inspection of the facility to verify the POC was cleared and the facility remained in compliance following LPA's 05/11/2023, inspection visit. Today, LPA verified the following POC was cleared:

Type B POCs:
102416.5(d)

There are no deficiencies cited during today's POC inspection. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with licensee, Maria L. Martinez. A copy of POC letter was issued.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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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