Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005347
Report Date: 03/07/2018
Date Signed 03/07/2018 04:47:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MOORE, ELIANA C.FACILITY NUMBER:
214005347
ADMINISTRATOR:MOORE, ELIANA C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 891-8676
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:14CENSUS: 12DATE:
03/07/2018
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Eliana MooreTIME COMPLETED:
04:45 PM
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  1. LPA Ng made a POC visit to the facility at issue, present was the provider with an aide and 12 children. The reason for the visit was explained to the provider. The CO detector was installed and inspected. A quick inspection of the facility was performed. there were no deficiencies observed.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2018
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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