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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409337
Report Date: 11/10/2022
Date Signed: 11/10/2022 02:54:12 PM

Document Has Been Signed on 11/10/2022 02:54 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:WASHINGTON, MARIJOFACILITY NUMBER:
073409337
ADMINISTRATOR:WASHINGTON, MARIJOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 383-6070
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Marijo WashingtonTIME COMPLETED:
03:30 PM
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On 11/10/2022 at 2:15 PM, Licensing Program Analyst (LPA) Christina Watts conducted an announced returned prelicensing inspection and met with Applicant, Marijo Washington, who has applied for a Large Family Child Care Home with a capacity of fourteen (14). Only applicant was present during inspection.

On 11/07/2022, LPA conducted an initial pre licensing inspection for facility. During inspection, LPA observed a swing set with a slide in the backyard. The play structure was not mounted and LPA informed applicant she has to either mount the play structure and have a mat or item that can absorb fall or remove the play structure from the backyard.

At today's inspection, LPA observed that play structure has been removed from the backyard.

As of 11/10/2022, applicant Marijo Washington has been approved to be licensed as a large family child care home.

Exit interview was conducted with Applicant, Marijo Washington and signed the report acknowledging receipts of documents.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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