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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422003
Report Date: 03/04/2024
Date Signed: 03/04/2024 12:09:20 PM

Document Has Been Signed on 03/04/2024 12:09 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:OUSD - UNITED NATION CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013422003
ADMINISTRATOR:MANSKER, ANNAFACILITY TYPE:
850
ADDRESS:1025 - 4TH AVETELEPHONE:
(510) 273-1616
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 168TOTAL ENROLLED CHILDREN: 168CENSUS: DATE:
03/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Mirsha Heredia/Jacquetta WallaceTIME COMPLETED:
12:15 PM
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On 03/04/2024 at 9:15 AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management inspection to follow up on a self-reported incident that occurred at the facility. LPA met with Site Principal, Mirsha Heredia, and Lead Teacher, Jacquetta Wallace, to explain the purpose of today's visit. LPA toured the facility, reviewed staff files, reviewed video footage, and conducted interviews with staff. No deficiencies are being cited today.


Exit interview conducted, appeal rights were given, and report was reviewed with the Site Principal, Mirsha Heredia.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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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