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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415785
Report Date: 05/09/2024
Date Signed: 05/09/2024 11:02:40 AM

Document Has Been Signed on 05/09/2024 11:02 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LOPEZ, EUFEMIAFACILITY NUMBER:
013415785
ADMINISTRATOR/
DIRECTOR:		LOPEZ, EUFEMIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 889-8339
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Eufemia LopezTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On May 9, 2024 at 10:20 AM Licensing Program Analyst (LPA) Elimika Woods met with licensee Eufemia Lopez for an Unannounced Case Management Visit. Licensee requested to close her family child care home and LPA Woods provided the licensee with a copy of her licensee. The licensee said she left some voice messages to close her facility but LPA explained that the request had to be in writing and she had to use the back of her licensee to make the request.

LPA gave the licensee a copy of her license which was signed and dated for processing.

Exit interview conducted and report was reviewed with the licensee, Eufemia Lopez

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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