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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419852
Report Date: 06/07/2022
Date Signed: 06/07/2022 11:23:33 AM

Document Has Been Signed on 06/07/2022 11:23 AM - 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:COLEMAN, MECCAHFACILITY NUMBER:
013419852
ADMINISTRATOR:COLEMAN, MECCAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 421-6015
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:TIME COMPLETED:
11:25 AM
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On June 7, 2022 Licensing Program Analyst (LPA) Indira Loza attempted a case management visit with the Licensee due to no contact. The home is enclosed with a locked iron gate. LPA clanked on the gate several times in an attempt to gain attention of the residents in the home but no one came out. LPA spoke to a neighbor two houses down who stated they used to see the Licensee with children but has not seen any children in the past month. LPA then spoke to another neighbor next door from the Licensee's home who stated that although they see the licensee with their own children, they haven't seen her with other children at her home. The neighbor could not recall the last time they saw the Licensee with daycare children. LPA will send a letter to attempt contact with the Licensee.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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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