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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409126
Report Date: 09/25/2024
Date Signed: 09/25/2024 03:11:12 PM

Document Has Been Signed on 09/25/2024 03:11 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:ALLEN, MELISSAFACILITY NUMBER:
073409126
ADMINISTRATOR/
DIRECTOR:		ALLEN, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 509-4014
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/25/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:MELISSA ALLENTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On September 25, 2024 Licensing Program Analyst (LPA) Tasha Alexander met with Licensee Melissa Allen for a CASE MANAGEMENT visit to inspect the newly constructed room added to the facility and change the off-limits and on-limits areas for day care. Present for today's inspection is licensee and her two (2) minor children, son 8 years old and daughter 6 years old.

PREVIOUSLY ON-LIMITS AND OFF LIMITS AREAS:

ON LIMITS AREA: hallway bathroom, kitchen, living room, dining room and child care room (sunroom).
OFF LIMITS AREA: All Three (3) bedrooms, master bathroom, garage and the side yard on the left side of the backyard.
ISOLATION AREA: Living Room

Today the newly added bathroom located inside of the sun room was inspected and found to be free of hazardous materials/items and safe for children's use.

THE NEW ON-LIMITS AND OFF LIMITS AREAS:

ON LIMITS AREA: sun room/bathroom (child care room),and backyard

OFF LIMITS AREA: The entire inside of the home.

ISOLATION AREA: an area in the corner of the child care room (sun room)

The facility operates on a part time schedule (Mon-Thur 8:50am-1:10pm) and children do not nap at the facility. Licensee does not care for infants/children under 2 years old. Parents enter through the backyard's side gate to drop-off and pick-up children from the facility.
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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