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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070209916
Report Date: 11/14/2024
Date Signed: 11/14/2024 10:56:05 AM

Document Has Been Signed on 11/14/2024 10:56 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:SRVSACCA - KIDS COUNTRY-JOHN BALDWINFACILITY NUMBER:
070209916
ADMINISTRATOR/
DIRECTOR:		ELIZABETH CASTILLOFACILITY TYPE:
840
ADDRESS:741 BROOKSIDE DRIVETELEPHONE:
(925) 831-3530
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 128TOTAL ENROLLED CHILDREN: 128CENSUS: 11DATE:
11/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:ROZES, REGINATIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On November 14, 2024 at 8:50am Licensing Program Analyst (LPA) Nyeesha Blount met with Director Rozes, Regina and Assistant Director Stephanie Machado to conduct an unannounced case management in regards to an unusual incident reported to the Oakland Regional Office on November 7, 2024. LPA interviewed Director and Assistant Director regarding the incident that occurred in the school classroom. Children were currently in the classroom unable to interview.

No deficiencies cited during today's visit.
Exit interview conducted.
A copy of the report and appeal rights provided to Director Rozes, Regina.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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