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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002137
Report Date: 11/17/2022
Date Signed: 11/17/2022 11:39:01 AM

Document Has Been Signed on 11/17/2022 11:39 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:TEJADA, GRACIELA Y.FACILITY NUMBER:
414002137
ADMINISTRATOR:TEJADA, GRACIELA Y.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 401-3821
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Graciela TejadaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an announced case management inspection initiated by Licensee Graciela Tejada and met with Licensee. License is currently on an inactive status due to the Licensee needing to move out of the home unexpectedly because of a water leak in the walls and necessary construction needing to be done.

LPA inspected home with Licensee for health and safety hazards prior to reopening. Day Care Areas: Kids room #1, kids room #2, bathroom #3, and backyard. Off Limit Areas: Living room, kitchen, master bedroom, bedroom #2, bedroom #3, master bathroom, bathroom #2, garage, and unit located at the back of the backyard. Off limit areas of the home are in the process of being reconstructed. Door to off limit areas will be fully barricaded and inaccessible to children in care. Entrance to the daycare will continue to be located through the side gate of the home.

LPA will approve for Licensee to reopen her daycare in her home and remove inactive status of license effective today, November 17, 2022. Fire clearance inspection was conducted and granted on November 14, 2022. Temporary license #414004901 will be closed as of December 2, 2022 to give Licensee time to move belongings back into home.

Licensee will contact LPA to schedule another case management visit once reconstruction of home is complete to conduct another health and safety inspection of entire home.

Report was reviewed and discussed with Licensee Graciela Tejada. A copy of report was provided.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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