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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417521
Report Date: 05/11/2023
Date Signed: 05/11/2023 01:34:30 PM

Document Has Been Signed on 05/11/2023 01:34 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:CAPERS, CARMELFACILITY NUMBER:
013417521
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
05/11/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Carmel CapersTIME COMPLETED:
01:35 PM
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On 05/11/2023 at approximately 12:35 PM, Licensing Program Analyst (LPA) Elimika Woods met with Carmel Capers for an ANNOUNCED CASE MANAGEMENT CAPACITY INCREASE INSPECTION. Also present for this visit were four preschool age children, one infant, the licensee's fingerprint husband, G Capers and daughter S. Capers.

The home was toured to conduct a Health and Safety Inspection. There are no changes to the home since the last inspection visit on 05/09/22. The on limits area consist of the living room, dining room, kitchen, all bedrooms, and bathrooms. The off-limits areas is the laundry which is made inaccessible by a gate/barrier, There are age appropriate toys in the home. There are no pools, hot tubs or any other bodies of water. There are no firearms in the home as stated by the licensee. LPA did not observe any hazardous materials or toxins accessible to children today. There are no deficiencies cited today.

LPA reviewed the application prior to this visit and the home has an approved fire clearance from the Alameda Fire Department dated 5/05/2023.

Based on the approval of the fire clearance, issuance of license for capacity change is recommended for this home effective today 5/11/2023. Exit interview was conducted with licensee, Carmel Capers. A copy of this report was issued to licensee and is to remain in the facility records for a period of 3 years.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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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