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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419051
Report Date: 02/18/2022
Date Signed: 02/18/2022 02:38:47 PM

Document Has Been Signed on 02/18/2022 02:38 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:NEWMAN, CHISHIROFACILITY NUMBER:
013419051
ADMINISTRATOR:NEWMAN, CHISHIROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 336-0299
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
02/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Chishiro NewmanTIME COMPLETED:
03:00 PM
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On 2/18/22 at 12:31PM, Licensing Program Analyst (LPA) Catherine Fernandes conducted a case management visit, LPA Fernandes was greeted by Licensee Chishiro Newman. Present for this inspection were four infants, six toddlers and two staff members.

The purpose of the inspection is to put a bedroom as an on-limit area. LPA Fernandes inspected the bedroom on the left side of the hallway and as of 2/18/22 the room is now on limit.

During the inspection LPA Fernandes reviewed safe sleep regulations with the Licensee and staff members. LPA also provided the safe sleep pamphlet.


Exit interview conducted
Report, Appeal Rights and notice of site visit was provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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