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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409372
Report Date: 08/29/2023
Date Signed: 08/29/2023 12:15:15 PM

Document Has Been Signed on 08/29/2023 12:15 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:DOBOUE, MARIEFACILITY NUMBER:
073409372
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:MARIE DOBOUETIME COMPLETED:
12:30 PM
NARRATIVE
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH LICENSEE MARIE DOBOUE FOR A PLAN OF CORRECTION VISIT TO CLEAR ANY DEFICIENCIES CITED DURING THE COMPLAINT INVESTIGATION ON 8/21/23. PRESENT FOR TODAY'S INSPECTION IS LICENSEE AND 4 INFANTS IN CARE (OVER 12 MONTHS OLD).

DURING THIS ANALYST'S LAST VISIT, THE FACILITY WAS FOUND TO BE OUT OF RATIO BY 1 INFANT. TODAY, LICENSEE HAS REDUCED THE AMOUNT OF INFANTS IN CARE BY 1.

TODAY, THE DEFICIENCY WILL BE CLEARED.

AN EXIT INTERVIEW WAS CONDUCTED

A NOTICE OF SITE VISIT WAS POSTED.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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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