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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423286
Report Date: 11/28/2023
Date Signed: 11/28/2023 12:13:56 PM

Document Has Been Signed on 11/28/2023 12:13 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:DALLAS, CALETHAFACILITY NUMBER:
013423286
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/28/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Caletha DallasTIME COMPLETED:
02:46 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Caletha Dallas for an Unannounced Annual Random Inspection. Present for this visit was the licensee, and 3 pre school age children and 2 infants (5 total). The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:30AM until 5:15 PM, MONDAY-FRIDAY.


The home is a two story house which is neat and clean with heating and ventilation for the safety and comfort of the children. The OFF LIMIT AREAS are the garage, entire second floor of the home. The off limit areas will be blocked by gate, safety handles and or visual supervision.The ON LIMIT AREAS are the living room, the dinning, the kitchen, the downstairs half bathroom and portion of the backyard. The ISOLATION AREA will be in the living room on the smaller rocking chair area.
There are no pools, hot tubs or any other bodies of water on the premises. All hazardous materials and toxins are kept out of the reach of children.The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The Licensee’s Health and Safety training is completed and CPR and First Aid certificates are current and expire NOVEMBER 2025. Per licensee, there are no firearms in the home.


The licensee's mandated reporter training is current and expires (MARCH 2025).The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on NOVEMBER 13, 2023.

2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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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