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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010216109
Report Date: 02/16/2023
Date Signed: 02/16/2023 11:05:25 AM

Document Has Been Signed on 02/16/2023 11:05 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:OAKLAND HEAD START - BROOKFIELDFACILITY NUMBER:
010216109
ADMINISTRATOR:ORURUO, VIVIANFACILITY TYPE:
850
ADDRESS:9600 EDES AVENUETELEPHONE:
(510) 615-5737
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 18DATE:
02/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Joy CironTIME COMPLETED:
11:15 AM
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LPA L. Dyer met with Teacher Joy Ciron for a Case Management Visit as a result of receiving an Unusual Incident Report. LPA toured the facility and interviews were conducted.

As a result of this visit, there are no deficiencies cited. Notice of Site Visit must be posted for 30 days. Exit interview conducted with Joy Ciron.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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