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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419824
Report Date: 06/03/2024
Date Signed: 06/03/2024 03:27:58 PM

Document Has Been Signed on 06/03/2024 03:27 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:CHAVEZ, MARJORIEFACILITY NUMBER:
013419824
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, MARJORIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 393-5063
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
06/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Marjorie ChavezTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On June 3, 2024 at approximately 2:45 PM, Licensing Program Analyst (LPA) Elimika Woods arrived for a Case Management visit and met with Licensee Marjorie Chavez. The purpose of the visit was to place her backyard area to off-limits until her property management could come out and repair the broken fence. There was one child present during today's inspection. The home was toured to conduct a health and safety inspection. The licensee stated that the facility operates from Monday to Friday 5:30 AM to 6:30 PM.

On-limit-areas are the: Bedroom (1) in the front middle area of home, living room, dining room, kitchen, and hallway bathroom,

Off-limit-areas are the: Backyard, bedroom (2) bedroom (3), and first and second garage.

LPA Woods updated the On/Off limits areas of the home which now includes the BACKYARD area as an off-limits area. The licensee was also reminded to call her LPA to schedule an appointment to get her backyard area placed back on limits after the repairs have been done and for the facility not to allow any children in the backyard area until approved.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Marjorie Chavez.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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