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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700405
Report Date: 04/19/2023
Date Signed: 04/19/2023 09:18:22 AM

Document Has Been Signed on 04/19/2023 09:18 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:RODRIGUEZ, KARLAFACILITY NUMBER:
015700405
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
04/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Karla RodriguezTIME COMPLETED:
09:40 AM
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On April 19, 2023 at approximately 8:25 AM Licensee Program Analyst (LPA) Elimika Woods met with licensee, Karla Rodriguez to make an announced visit to conduct and inspection for a CAPACITY CHANGE. Present during today inspection was the licensee's fingerprint cleared assistant, K. Jordan-Lopez, and four (4) infants. Licensee stated that the facility operates from Monday to Friday 8:00 AM to 5:30 PM.

LPA conducted a health and safely inspection of the facility. There are no changes to the home since the last inspection visit on 12/12/2022. The facility was granted a fire clearance on April 3, 2023 from the Hayward Fire Department. The kitchen area has a pull down fire alarm, dual working smoke and carbon monoxide detectors and a fully charged 2A10BC fire extinguisher which meets standards established by the State Fire Marshal.

On- Limit areas are the: Living and dining room, patio, bathroom on second level, bedroom downstairs, and kitchen

Off- Limit areas are the: Entire third level of home, downstairs bathroom in the bedroom, and garage

Home inspection was done on all on limits areas. Age appropriate toys were present inside the facility and outdoors as well and all were in good working order. Kitchen area had appropriate locks and latches on cabinet doors and drawers. The bathroom for the children was checked and everything was in proper working order. The licensee will utilize the local park for outdoor play activities. Licensee will provide 100% visual supervision during outdoor play when away from the facility.

Licensee was reminded there needs to be a fingerprint cleared assistant working in a large facility and if the licensee is the only person present, the facility must be operated as a small facility with a maximum of eight (8) children.

The facility is approved for the capacity change effective April 19, 2023. A new license will be printed and a record of this will remain on file. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Karla Rodriguez.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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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