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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408850
Report Date: 05/09/2024
Date Signed: 05/09/2024 04:07:21 PM

Document Has Been Signed on 05/09/2024 04:07 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CANNADA, NICOLEFACILITY NUMBER:
073408850
ADMINISTRATOR/
DIRECTOR:		CANNADA, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 325-5993
CITY:BAY POINTSTATE: CAZIP CODE:
94565
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/09/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Cannada NicoleTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 5/9/24 Licensing Program Analysts(LPA's) Brindha Govindasamy and Diana Campos made an unannounced case management- licensee initiated inspection and met with Licensee Nicole Cannada. Present during the inspection was the licensee, her finger printed spouse, 2 minor children (picked up from school by spouse during inspection) 2 small pet dogs.There are no children in care during todays inspection. The purpose of the inspection was to place the home on active status and to conduct a health and safety check.
Operating hours will be 7:00am- 6:00pm, Monday through Friday.
Currently the backyard is OFF LIMIT. Licensee will inform Licensing Office when backyard is ready to be placed ON-LIMIT. LPAs confirmed and tested carbon monoxide detector in home.

The following needs to be completed prior to placing active status on license.
- Large Fish Aquarium - Netting for the top
- Ball pit - Mesh

No citations issued as result of this visit.

Notice of site visit was given to Licensee Nicole Cannada and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee Nicole Cannada.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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