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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200207
Report Date: 08/18/2022
Date Signed: 08/26/2022 11:05:26 AM

Document Has Been Signed on 08/26/2022 11:05 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, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ROBIN COURTFACILITY NUMBER:
019200207
ADMINISTRATOR:KRISTABELLE ALATASFACILITY TYPE:
735
ADDRESS:4736 ROBIN COURTTELEPHONE:
(510) 661-0444
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 6CENSUS: 26DATE:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Administrator-TIME COMPLETED:
12:40 PM
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This is a amended report. On 8/18/22, LPA L. Fici generated this report in error. LPA L. Fici met with Josephine Abella and explained purpose of visit. Annual inspection was conducted on 8/26/2022 refer to LIC 809 with this date.

Exit interview conducted and copy of report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2022
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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