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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700356
Report Date: 08/24/2023
Date Signed: 08/24/2023 01:55:28 PM

Document Has Been Signed on 08/24/2023 01:55 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:DIAZ MARTINEZ, OLGAFACILITY NUMBER:
435700356
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
08/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Olga Diaz MartinezTIME COMPLETED:
01:30 PM
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On 08/24/2023 at 12:30pm, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced Case Management visit for the purpose of a capacity increase. LPA Uribe met with licensee, Olga Diaz Martinez, and also present at the time of the inspection was 2 day care children. Language Link was used today for translation services between the licensee and LPA Uribe.

Application for Capacity Increase: All documents have been received for the increase of capacity application. The fire clearance for a capacity of 14 children was received from the Mountain View Fire Department on 08/11/2023. The licensee was reminded to abide by the conditions of the fire clearance which restricts the use of the garage to children in care.The licensee was reminded that an assistant must be present at all times when there is more than 8 children in attendance. Whenever the assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

Assistant Requirements: When the licensee has an assistant, the licensee will ensure that the assistant has the following documents and placed in a personnel file for review: 1) Mandated Reporter certificate for Child Care Providers, 2) Criminal Record Clearance and associated to the facility, 3) Proof of immunizations against Measles (MMR) & Pertussis (Tdap), 4) Proof of TB Clearance, & 5) Signed copy of the Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) Form.

The home is recommended for an increase of capacity and will go effective today, 08/24/2023.

A notice of site visit of given was given and must be posted for 30 days. Exit interview was conducted and report was reviewed with the licensee, Olga Martinez DIaz.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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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