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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407132
Report Date: 01/26/2023
Date Signed: 01/26/2023 01:47:17 PM

Document Has Been Signed on 01/26/2023 01:47 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:COLLINS, YVETTEFACILITY NUMBER:
073407132
ADMINISTRATOR:COLLINS, YVETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 777-1553
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
01/26/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Yvette CollinsTIME COMPLETED:
02:00 PM
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On 01/26/2023 at 1:20 PM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced case management inspection. LPA's met with licensee, Yvette Collins and explained the purpose of today's inspection. Office in the facility is currently off limits for children in care. Licensee requested for the office to be put in use for children in care.

LPA inspected office in facility. Office has electric screened fireplace that licensee stated she does not use. Licensee states electric fireplace is currently not plugged in. Office has clear screened divided. Plugs and outlets were covered and made inaccessible for children in care. Licensee stated she will not use office primarily as child care area however licensee wants area to be in use for napping.

Office is approved for IN USE for day-care as of 01/26/2023.

Exit interview was conducted with licensee, Yvette Collins and the report was signed acknowledging receipts of documents. 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: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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