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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423888
Report Date: 01/30/2025
Date Signed: 01/30/2025 11:16:24 AM

Document Has Been Signed on 01/30/2025 11:16 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BALICKI, MARY-ETTAFACILITY NUMBER:
013423888
ADMINISTRATOR/
DIRECTOR:		MARY-ETTA BALICKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 801-5865
CITY:OAKLANDSTATE: CAZIP CODE:
94618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
01/30/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Mary-Etta "Meg" BalickiTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 01/30/2025 at 9:15 AM, Licensing Program Analyst (LPA) Christina Watts conducted a Case Management inspection for licensee, Mary-Etta "Meg" Balicki large family home. Licensee would like to add on living room/dining room and kitchen as a area to care and supervise children. During today's inspection, there were 8 children in care (4 infants and 4 preschoolers) with 2 assistants. Licensee stated there are 8 children enrolled. Also present during inspection was licensee's spouse. Licensee and all adult living in the home and/or supervising children have Criminal Record Clearance.

LPA conducted an health and safety inspection of the living room/dining room. LPA observed toys, equipment and other items that are age appropriate for children to play with. LPA also observed a gate to separate children from the living room/dining room to the kitchen. Licensee also stated they wanted the kitchen to be placed on limits as a walkway from the the living room/dining room to the back entry way that leads to the backyard. LPA conducted a health and safety inspection of the kitchen. LPA informed licensee that knobs are to be placed on stove and the dishwasher is to be made inaccessible to children in care. LPA also informed licensee that the door to the bedroom and stairs are to be made inaccessible to children in care.

AS OF 01/30/2025, THE LIVING ROOM/DINING ROOM AND KITCHEN are placed on limits for children.

During today's inspection, there were no violations observed.

Exit interview conducted and report was reviewed with the licensee, Meg Balicki. A notice of site visit was given and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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