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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408806
Report Date:
08/11/2022
Date Signed:
08/11/2022 04:06:05 PM
Document Has Been Signed on
08/11/2022 04:06 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:
SMITH, ALISA
FACILITY NUMBER:
073408806
ADMINISTRATOR:
SMITH, ALISA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(415) 724-5814
CITY:
DISCOVERY BAY
STATE:
CA
ZIP CODE:
94505
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
10
CENSUS:
DATE:
08/11/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:40 PM
MET WITH:
Kathy Nord and Vanessa Rodriguez-Williams
TIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management inspection to follow up on a self reported incident. Licensee was not home during the inspection. LPA met with fingerprint cleared assistants and spoke to licensee over the telephone. There were two preschool aged children and one infant present when LPA arrived. Nine school aged children arrived during the visit.
During the inspection LPA obtained a copy of documents including the facility roster. LPA conducted interviews.
There are no deficiencies cited during today's inspection.
Notice of Site Visit was provided and must be posted for 30 days
Exit interview and report reviewed with Vanessa Rodriguez-Williams and with Alisa Smith over the telephone.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Cherie Acosta
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
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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