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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070207368
Report Date: 03/15/2023
Date Signed: 03/15/2023 09:25:24 AM

Document Has Been Signed on 03/15/2023 09:25 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MORAGA VALLEY PRESBYTERIAN CHURCH NURTURYFACILITY NUMBER:
070207368
ADMINISTRATOR:CAROLYN NAKAOFACILITY TYPE:
850
ADDRESS:10 MORAGA VALLEY LANETELEPHONE:
(925) 376-4800
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 42DATE:
03/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Carolyn NakaoTIME COMPLETED:
09:26 AM
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On March 15, 2023 at 8:52am Licensing Program Analyst (LPA) Indira Loza arrived at the facility to deliver an amended report dated on September 23, 2022. LPA toured the facility for a health and safety inspection, there were 42 children and 10 staff.

Exit interview conducted with Director Carolyn Nakao.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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