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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700317
Report Date: 05/12/2023
Date Signed: 05/12/2023 09:12:18 AM

Document Has Been Signed on 05/12/2023 09:12 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:YEPEZ, DIEGOFACILITY NUMBER:
015700317
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
05/12/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Diego YepezTIME COMPLETED:
09:30 AM
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On 05/12/2023 at approximately 8:15 AM, Licensing Program Analyst (LPA) Elimika Woods met with Diego Yepez for an ANNOUNCED CASE MANAGEMENT CAPACITY INCREASE INSPECTION. Also present for this visit was the licensee's fingerprint cleared assistant, E. Rangelledezma and one preschool age child. Licensee stated that the facility operates from Monday to Friday 6:00 AM to 6:00 PM.

The home was toured to conduct a Health and Safety Inspection. There are no changes to the home since the last inspection visit on 01/20/23. The on limits area consist of the Living room, bedroom 2, bedroom 3, front and backyard, bathroom between bedroom two (2) and bedroom three (3), and kitchen. The off-limits areas is bedroom (1), shed in backyard, and laundry room. There are no pools, hot tubs or any other bodies of water. There are no firearms in the home as stated by the licensee.

The Outdoor Play area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. For outdoor activities, the licensee also states that he would utilizes the front-yard play area and the licensee is reminded to have 100% supervision at all times while in the front yard. LPA did not observe any hazardous materials or toxins accessible to children today.

LPA reviewed the application prior to this visit and the home has an approved fire clearance from the Hayward Fire Department dated 4/18/2023. There were no deficiencies cited during this visit.

Based on the approval of the fire clearance, issuance of license for capacity change is recommended for this home effective today 5/12/2023. Exit interview was conducted with licensee, Diego Yepez. A copy of this report was issued to licensee and is to remain in the facility records for a period of 3 years.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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