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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409074
Report Date: 11/03/2021
Date Signed: 11/03/2021 12:19:46 PM

Document Has Been Signed on 11/03/2021 12:19 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:OCAMPO, ROBERTOFACILITY NUMBER:
073409074
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/03/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Roberto OcampoTIME COMPLETED:
12:35 PM
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Licensing Program Analyst Caroline Colson met with Roberto Ocampo, Licensee, and his teenage daughter for an unannounced Plan of Correction Inspection. There are four (4) preschool children and one (1) infant present. All deficiencies have been cleared from the Case Management Inspection conducted on October 20, 2021.

An exit interview was conducted. Appeal rights were discussed. This report must be available for public review for 3 years.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2021
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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