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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423087
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:48:51 PM

Document Has Been Signed on 05/01/2024 03:48 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:Y-KIDS CORNELLFACILITY NUMBER:
013423087
ADMINISTRATOR/
DIRECTOR:		MAJANO, AILEENFACILITY TYPE:
840
ADDRESS:920 TALBOT AVENUETELEPHONE:
(510) 867-8349
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 67DATE:
05/01/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Kendrika WatsonTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 5/1/2024, at 2:45PM, Licensing Program Analyst (LPA) Brittany Crass, arrived at the facility for an unannounced case management visit to inspect a new play structure built on the already existing playground. LPA met with the Director, Kendrika Watson, to announce the reason for the visit. LPA toured the playground with the director. LPA observed Corkeen material underneath the playground structure and slides as cushioning. The play structure is age appropriate for ages 5-12 as per the manufacturing sticker on the structure.

This facility is approved to use the play structure as of today 5/1/2024.

Report was reviewed with the director. Appeal rights were given and discussed. Notice of site visit was given and must remain posted for 30 days. Report reviewed with the director, Kendrika Watson.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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