<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206146
Report Date: 05/04/2022
Date Signed: 05/04/2022 12:01:50 PM

Document Has Been Signed on 05/04/2022 12:01 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:OUSD - MANZANITAFACILITY NUMBER:
010206146
ADMINISTRATOR:BIRDIE WINROWFACILITY TYPE:
850
ADDRESS:2618 GRANDE VISTA AVENUETELEPHONE:
(510) 879-0829
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 79TOTAL ENROLLED CHILDREN: 50CENSUS: 33DATE:
05/04/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Caroline JonesTIME COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/04/2022 Licensing Program Analyst (LPA) Diana Campos arrived at the facility for the purpose of conducting a Case Management Annual Continuation inspection. LPA was met by Teacher Myesha Jones. Later, Site Administrator Caroline Jones joined the inspection. Present during this inspection were 33 pre-school children and 10 staff. Classrooms were free of toxins and hazardous materials. Electronic Sign in/out sheet was reviewed and found to be accurate with the children present today. LPA conducted a staff file review at 11:00am until 11:30am. Staff interview conducted with Site Administrator at 11:30am.
No deficiencies were cited during this inspection.
Exit interview conducted with Site Administrator Caroline Jones.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7