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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010216109
Report Date: 05/10/2023
Date Signed: 05/10/2023 12:58:18 PM

Document Has Been Signed on 05/10/2023 12:58 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: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: 26CENSUS: 18DATE:
05/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lourdes JimenezTIME COMPLETED:
01:10 PM
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On 5/10/23 at 11:30 AM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Case Management inspection about an unusual incident self reported by the Oakland Head Start- Brookfield Center. LPA met with Director Lourdes Jimenez and explained the purpose of today's inspection. All rooms were in ratio compliance during today's inspection.

LPA interviewed the staff, observed classrooms, received copies of the Children's Roster and Personnel Report LIC500.


As a result of this visit, there are no deficiencies cited during today's inspection. Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Lourdes Jimenez.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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