<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004007
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:10:45 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/25/2022 03:10 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PADILLA, ALEXFACILITY NUMBER:
414004007
ADMINISTRATOR:PADILLA, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 259-7978
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:EdwardTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 25, 2022, Licensing Program Analyst (LPA) Van conducted an unannounced required annual inspection. LPA rang the doorbell, and a gentleman answered the door. LPA introduced, explained the purpose of the inspection, and asked to speak to Alex Padilla. The gentleman, identified as Edward, stated that no one resided in this home with the name Alex Padilla. Edward stated that he's a new tenant and has just moved into this home in March. Per Edward, this property was vacant for several months prior to his move-in, and he does not know where the Licensee has moved to. During the conversation, LPA did not observe any children or hear any children at the home.

LPA called the facility phone number on the facility profile and spoke with Alex Padilla. Per a phone conversation with Alex Padilla, he mentioned that he had moved from the 1708 Toledo location. Mr. Padilla stated he is currently working on the new location and working on the paperwork to submit for the new location. LPA informed Mr. Padilla that since he no longer has control property of 1708 Toledo, a relocation application is no longer an option. He has to apply a brand new application.

Based on the inspection today, the information provided by the new tenant and conversation over the phone with Licensee Alex Padilla. Alex Padilla no longer had control of the property. The license attached to the 1708 Toledo ave address is longer valid, and all provision of care and supervision must cease. The Licensee is forfeited as of May 25, 2022. LPA will close this facility upon returning to the office, and a certified forfeiture letter will be sent.

No citations were given today.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1