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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005614
Report Date: 05/03/2022
Date Signed: 05/03/2022 10:28:11 AM

Document Has Been Signed on 05/03/2022 10:28 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:DUARTE, MARIANA P.FACILITY NUMBER:
214005614
ADMINISTRATOR:DUARTE, MARIANA P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 225-5982
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Applicant, Mariana DuarteTIME COMPLETED:
10:35 AM
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On May 3,2022 at 9:30am, Licensing Program Analyst (LPA) Kassandra Medrano made a subsequent pre-licensing visit. LPA met with applicant Mariana Duarte, the purpose of the visit was discussed. Present today in home is Applicant. LPA Medrano inspected the entire lower areas and the backyard. Yard is still under construction, applicant has properly barricaded the yard children will use to maintain the health and safety of the children. Applicant was reminded to maintain safe and healthy area while construction continues in yard. During previous inspection conducted on 4/20/2022, applicant was not officially moved into home and fire clearance had yet to be received. Fire clearance was received on 4/28/2022. Based on observations today, applicant has now moved into home, and yard has been fixed to meet licensing and fire requirements.

License will be recommended for approval today, May 03,2022.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant, Mariana Duarte.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2022
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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