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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700412
Report Date: 02/09/2023
Date Signed: 02/09/2023 04:35:11 PM

Document Has Been Signed on 02/09/2023 04:35 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:MINER, KAILANFACILITY NUMBER:
015700412
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
02/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kailan MinerTIME COMPLETED:
03:16 PM
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Licensing Program Analyst Sidney Cortez conducted a case management visit for licensee Kailan Miner. Licensee requested for a technical assistance visit--she had questions about adding her daughter's room as an on limit area. She asked for advice on how to properly baby proof the room--and abide by health and safety protocols.

Licensee also asked assistance on how to properly navigate the Guardian System (how to add and delete associations). And also went over the sleep log.


She also inquired about the process about how to increase the capacity, and what she needs to do on her physical plants to ensure that she is within regulation. LPA Cortez suggested that she will need to apply for increase capacity, and that she will need a fire clearance.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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