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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408850
Report Date: 11/02/2021
Date Signed: 11/02/2021 12:42:48 PM

Document Has Been Signed on 11/02/2021 12:42 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CANNADA, NICOLEFACILITY NUMBER:
073408850
ADMINISTRATOR:CANNADA, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 325-5993
CITY:BAY POINTSTATE: CAZIP CODE:
94565
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
11/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nicole CannadaTIME COMPLETED:
12:45 PM
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On 11/2/21 at 12:00 PM Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection at Nicole Cannada's family home. LPA met with Licensee Nicole and explained the purpose of today's inspection, to provide an exclusion letter for ZACHARY COBB. Licensee understands the requirements of the exclusion.
Present in the home during today's inspection were 9 children (4 infants, 5 preschool age), Licensee, Licensee's spouse and a female adult, all with criminal record clearances.

No deficiency was cited today. A Notice of Site Visit was issued, must be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
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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