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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408657
Report Date: 03/09/2023
Date Signed: 03/09/2023 04:39:36 PM

Document Has Been Signed on 03/09/2023 04:39 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MAGANA, SANDRAFACILITY NUMBER:
073408657
ADMINISTRATOR:SANDRA MAGANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 943-8780
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Sandra MaganaTIME COMPLETED:
04:54 PM
NARRATIVE
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On Thursday, March 9, 2023, at 1:55 PM, Licensing Program Analyst (LPA) Caroline Colson met with Joseline Calderon and Maritza Magana for an unannounced case management inspection. Language Link was used for Spanish Interpreter Services. Sandra Magana and Anderson Zapeda arrived during the inspection.

The attached type A deficiencies are being cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Please See LIC 809 D for Deficiencies

An exit interview was conducted. Appeal Rights were given. A notice of site visit was posted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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Document Has Been Signed on 03/09/2023 04:39 PM - It Cannot Be Edited


Created By: Caroline Colson On 03/09/2023 at 03:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MAGANA, SANDRA
FACILITY NUMBER: 073408657

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/09/2023
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance
Obtain a California clearance or a criminal record exemption as required by the Department or
Licensee allowed Maritza Magana to assist without a criminal record clearance while she was away from the facility.
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Maritza Magana left the facility during the inspection.
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This requirement was not met as evidenced by document review and observation. This poses an immediate health and safety risk to the children in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
Type A
03/09/2023
Section Cited
CCR102425(a)

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Infant Safe Sleep
There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.
There were two infants sleeping in a car seat when LPA arrived at the facility.
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Both infants were removed from the car seats during the inspection.
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This requirement was not met as evidenced by document review and observation. This poses an immediate health and safety risk to the children in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023


LIC809 (FAS) - (06/04)
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