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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407708
Report Date: 05/18/2023
Date Signed: 05/18/2023 11:56:14 AM

Document Has Been Signed on 05/18/2023 11:56 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:LOPEZ, GUADALUPEFACILITY NUMBER:
073407708
ADMINISTRATOR:LOPEZ, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 516-7645
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
05/18/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Guadalupe LopezTIME COMPLETED:
12:00 PM
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On 05/18/2023 at 11:15 AM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced Plan of Correction inspection at Guadalupe Lopez's large family home. LPA met with licensee and explained the purpose of today's visit. Present during inspection was 2 daycare children (1 infant and 1 preschooler) and licensee's husband. Licensee stated there are 6 children enrolled.

Facility was cited an Type A citation on May 10, 2023 for an uncleared adult living in the home and caring for children. LPA reviewed Guardian and uncleared adult is currently on the facility's roster in pending status. LPA did not observed uncleared adult in the home during inspection.

LPA informed licensee that uncleared adult cannot live in the home or present during daycare hours until granted clearance.

Deficiency has been cleared as of May 18, 2023.

Exit interview was conducted and report was reviewed with the licensee, Guadalupe Lopez. 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: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2023
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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