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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423697
Report Date: 06/07/2023
Date Signed: 06/07/2023 01:57:54 PM

Document Has Been Signed on 06/07/2023 01:57 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:WALKER, MEGANFACILITY NUMBER:
013423697
ADMINISTRATOR:WALKER, MEGANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(602) 206-4522
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Megan WalkerTIME COMPLETED:
02:05 PM
NARRATIVE
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On 06/7/23, Licensing Program Analysts (LPAs) Melissa Domantay and Melissa Guirit arrived unannounced on a case management inspection as a result of an individual who was present at the home who was finger print cleared, but not associated to the facility. LPAs met with licensee, Megan Walker. There were 2 infants, 3 children, and an Assistant that is a minor. A tour of the home with the licensee was conducted to ensure the Health and Safety of children in care.

All required forms are posted on the licensee's parent board.

See 809-D for the Type A deficiency which will now result in a civil penalty.

Exit interview conducted with licensee, Megan Walker. A copy of this report was provided to licensee.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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Document Has Been Signed on 06/07/2023 01:57 PM - It Cannot Be Edited


Created By: Melissa Domantay On 06/07/2023 at 11:52 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WALKER, MEGAN
FACILITY NUMBER: 013423697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/08/2023
Section Cited
CCR
102416.5(d)(2)

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102416.5(d)(2)Request a transfer of a criminal record clearance as specified in Section 102370(j) or
This requirement has not been met as evidenced by:
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Licensee shall ensure all staff will be finger print cleared, requested a transfer, and associated to their facility license prior to being present at the home.
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Based on staff interviews and review of staff roster. Individual was who was present was finger print cleared but did not show association under the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Melissa Domantay
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


LIC809 (FAS) - (06/04)
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