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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423067
Report Date: 10/06/2022
Date Signed: 10/06/2022 10:27:33 AM

Document Has Been Signed on 10/06/2022 10:27 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:OAK CENTER CULTURAL CENTER, INC.FACILITY NUMBER:
013423067
ADMINISTRATOR:JORDAN, MARYFACILITY TYPE:
850
ADDRESS:1324 ADELINE STREETTELEPHONE:
(510) 891-0035
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
10/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Deltrina JohnsonTIME COMPLETED:
10:41 AM
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On 10/06/2022 Licensing Program Analysts (LPAs) Melissa Guirit and Melissa Domantay conducted an unannounced case management inspection at the facility above in regard to unusual incident that occurred on 9/13/2022 where a child was said to be pinched by a teacher. LPAs met Director, Deltrina Johnson. Staff Interviews were conducted with Teachers that were present during the incident and Director. Staff interviews determined that the child in the incident was not harmed in any way when teacher was getting the child out from under the chair.

No deficiencies being cited today.

An exit interview was conducted with Director Deltrina Johnson and report and notice of site was provided. Appeal rights provided.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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