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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417870
Report Date: 12/20/2022
Date Signed: 12/20/2022 10:56:19 AM

Document Has Been Signed on 12/20/2022 10:56 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:THOMPSON-HAMILTON, KEISHNAFACILITY NUMBER:
013417870
ADMINISTRATOR:THOMPSON-HAMILTON, KEISHNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5106356884
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
12/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Keishna Thompson-HamiltonTIME COMPLETED:
11:08 AM
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LPA Lisa Dyer met with Licensee Keishna Thompson-Hamilton for a case management inspection.

Present at the facility is the licensee, one fingerprint cleared assistant, 1 infant, 1 preschooler, and 5 school-age children.

As a result of this visit, there are no deficiencies cited.

Appeal rights were given. A site visit notice was posted.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2022
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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