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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073400249
Report Date:
10/17/2024
Date Signed:
10/17/2024 03:28:26 PM
Document Has Been Signed on
10/17/2024 03:28 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:
CONTRA COSTA CO. HEAD START - BALBOA CDC
FACILITY NUMBER:
073400249
ADMINISTRATOR/
DIRECTOR:
DOSS, MARILYN
FACILITY TYPE:
850
ADDRESS:
1001 S. 57TH STREET
TELEPHONE:
(510) 374-7025
CITY:
RICHMOND
STATE:
CA
ZIP CODE:
94804
CAPACITY:
140
TOTAL ENROLLED CHILDREN:
140
CENSUS:
38
DATE:
10/17/2024
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:
Marilyn Doss
TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Case Management-Collateral inspection to conduct an interview regarding a self reported incident for another location. LPA met with Director Marilyn Doss. There were 14 staff and 38 children present during the inspection.
There are no deficiencies cited during today's inspection.
Exit interview and report reviewed with Director Marilyn Doss.
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Diana Campos
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/17/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/17/2024
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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