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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422129
Report Date: 03/05/2024
Date Signed: 03/05/2024 01:58:37 PM

Document Has Been Signed on 03/05/2024 01:58 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:JAMULA, MARGOTFACILITY NUMBER:
013422129
ADMINISTRATOR:JAMULA, MARGOTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 306-0111
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Margot ZavaletaTIME COMPLETED:
02:00 PM
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On 3/5/2024, Licensing Program Analysts (LPAs) Catherine Fernandes and Janai McClain arrived unannounced on a case management visit regrading the License's inactive status.

LPAs met with Licensee's mother Margot Zavaleta whom stated her daughter is no longer caring children.

LPAs spoke the licensee whom confirmed she would like to close the license.



Exit interview conducted
Report and Appeal Rights provided
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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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