<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518855
Report Date: 04/13/2022
Date Signed: 04/13/2022 09:55:03 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/13/2022 09:55 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:JONES, LISAFACILITY NUMBER:
410518855
ADMINISTRATOR:JONES, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 329-9858
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Lisa JonesTIME COMPLETED:
09:38 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On April 13, 2022, at 9:25 am, Licensing Program Analyst (LPA) April Cowan, Met with licensee Lisa Jones for an unannounced annual inspection. Currently in the home is licensee and her husband. The purpose of the visit was mentioned to licensee and spouse, and LPA was granted entrance into the home. Licensee states that she is ill and has not been providing day care for a couple of years. LPA observed that there are no children present in or around the home. Licensee states that she is thinking about closing her license, but may go on inactive status after her licensing fees have been brought to current status. Per licensee, the rear of the home is no longer set up for day care but is not used for storage. LPA gave licensee Licensing contact information. No inspection has occurred and no care tool has been opened.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1