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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421537
Report Date: 01/30/2023
Date Signed: 01/30/2023 03:33:26 PM

Document Has Been Signed on 01/30/2023 03:33 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:ROBINSON, VALERIEFACILITY NUMBER:
013421537
ADMINISTRATOR:ROBINSON, VALERIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 606-3538
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/30/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Valerie RobinsonTIME COMPLETED:
03:45 PM
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On January 30, 2023 LIcensing Program Analyst Sidney Cortez conducted a case management visit as a technical assistant for licensee: Valefis Robinson. She had questions about the safe sleep regulations and forms--for she will start to have infants in care. In addition, she needed assistance with Guardian (being able to add, and delete personnel on the system).

LPA Cortez also provided advice on record-keeping; and reminded the licensee that mandated reporter and CPRFirst Aid Training are due every 2 years.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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