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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423650
Report Date: 07/30/2021
Date Signed: 07/30/2021 01:08:26 PM

Document Has Been Signed on 07/30/2021 01:08 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:CASTRO, ANAFACILITY NUMBER:
013423650
ADMINISTRATOR:CASTRO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 512-6467
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/30/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ana CastroTIME COMPLETED:
02:00 PM
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On 07/30/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an announced visit for the purpose of conducting a prelicensing inspection, change of location. No children were present for the visit. The applicant lives alone. LPA toured the home with the applicant.

The home is a one story home with two bedrooms, one bathroom, and a fenced backyard. The applicant plans to provide care Monday through Friday from 8:00am to 5:00pm. Applicant will provide snack and lunch. The entire home is on limits except for Bedroom 2.The primary day care area will be in the living room. The first bedroom will be used as an additional play area. Applicant has cots for the children to sleep on. Nap time will be in the living room. There is a fireplace in the living room that is blocked. There is a working carbon monoxide detector and a fully charged 3A40BC fire extinguisher. Outdoor play area was inspected and found free of hazards. LPA observed age appropriate toys throughout the home and outdoor play area.
LPA gave the applicant forms regarding safe sleep. LPA emailed COVID-19 postings to the applicant.

The following corrections need to be made prior to licensure:
1. Locks need to be placed in the on limit areas of the kitchen where hazardous items are accessible (anything sharp, plastic bags, etc).
2. Required postings shall be posted and readily available upon entry.
3. COVID-19 flyers limiting visitors and symptoms posted.

LPA will return on 08/02/2021 to verify the corrections have been made and proceed with licensure.
Exit interview conducted and a copy of this report was left with Ana Castro.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2021
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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