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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403820
Report Date: 05/15/2024
Date Signed: 05/15/2024 12:25:35 PM

Document Has Been Signed on 05/15/2024 12:25 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CRUZ, MARIAFACILITY NUMBER:
073403820
ADMINISTRATOR/
DIRECTOR:		CRUZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 687-8095
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Maria CruzTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 5/15/2024 Licensing Program Analyst Dealia Frison and Cherie Acosta conducted an unannounced visit in regards to inactive status. LPA's met with Licensee Maria Cruz.

During inspection, Licensee requested to be on inactive status from 4/28/24-4/28/25. Licensee understands that before caring for children she must contact community care licensing. Licensee also understands she must continue paying for annual fees during inactive status.

During the inspection Licensee gave LPA a copy of signed form (LIC 9211) that was sent out by LPA.

Exit interview report was review with Licensee Maria Cruz.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Dealia Frison
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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