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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420280
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:07:45 PM

Document Has Been Signed on 11/16/2022 04:07 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:WILLIAMS, FRANKIE & ROBERTFACILITY NUMBER:
013420280
ADMINISTRATOR:WILLIAMS, FRANKIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 536-6398
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
11/16/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Robert WilliamsTIME COMPLETED:
04:15 PM
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On November 16, 2022 at approximately 3:30pm LPAs Haderer and Dacanay-Breaux arrived unannounced to clear plan of corrections issued on visit from October 20, 2022. Present for the visit was both licensee's and 4 children in care. The home is in ratio today.

Licensee had parents complete the LIC 700 ID and LIC627 Consent for Emergency Medial treatment forms. . The deficiency was cleared this day.

A notice of site visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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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