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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070213664
Report Date: 10/23/2023
Date Signed: 10/23/2023 10:01:59 AM

Document Has Been Signed on 10/23/2023 10:01 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:BARKSDALE, ELLASTINEFACILITY NUMBER:
070213664
ADMINISTRATOR:BARKSDALE, ELLASTINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 640-0032
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Ellastine BarksdaleTIME COMPLETED:
10:05 AM
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On October 23, 2023 at 9:41am Licensing Program Analyst (LPA) Indira Loza met with Licensee Ellastine Barksdale for the purpose of conducting a POC visit. Present during today's inspection was the Licensee, one infant, and 3 preschool age children. LPA conducted a tour for a health and safety check.

On June 9, 2023 the Licensee was cited CCR 102425(j)(2) for having an uncleared adult present and CCR102416.5(e) for being out of ratio. LPA checked the facility for the uncleared adult and they were not present. The Licensee was also in ratio today. Therefore, both citations will be cleared.

There were no deficiencies issued during todays visit.
Report and appeal right reviewed and provided to Licensee Ellastine Barksdale.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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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