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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215400
Report Date: 03/05/2024
Date Signed: 03/05/2024 09:22:18 AM

Document Has Been Signed on 03/05/2024 09:22 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:LOCKWOOD STEAM PRESCHOOLFACILITY NUMBER:
010215400
ADMINISTRATOR:LEON, BENJAMINFACILITY TYPE:
850
ADDRESS:6701 INTERNATIONAL BLVD.TELEPHONE:
(510) 879-0827
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
03/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH: Reyna Diaz-ZamoraTIME COMPLETED:
09:30 AM
NARRATIVE
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On 03/05/2024 at 8:45AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced Case Management visit to dismiss a deficiency (HSC 1596.954) that was cited on 02/05/2024. LPA met with the Lead Teacher, Reyna Diaz-Zamora, to explain the purpose of today's visit. The Lead Teacher was provided a new LIC 809D form that indicates the deficiency is dismissed.


Exit interview conducted, appeal rights were given, and report was reviewed with the Lead Teacher, Reyna Diaz-Zamora.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
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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