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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073407449
Report Date:
10/24/2022
Date Signed:
10/24/2022 11:23:09 AM
Document Has Been Signed on
10/24/2022 11:23 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:
AIM HIGH CHILD CARE CENTER
FACILITY NUMBER:
073407449
ADMINISTRATOR:
BORGES, JESSICA
FACILITY TYPE:
840
ADDRESS:
2010 SHADY WILLOW LANE
TELEPHONE:
(925) 634-0998
CITY:
BRENTWOOD
STATE:
CA
ZIP CODE:
94513
CAPACITY:
75
TOTAL ENROLLED CHILDREN:
75
CENSUS:
0
DATE:
10/24/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Jessica Borges
TIME COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Case Management visit in regards to a self reported incident. LPA met with Director Jessica Borges. There were no children in care during the visit.
During the visit LPA toured the outdoor play area and reviewed files.
Exit interview and report reviewed with Jessica Borges.
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Cherie Acosta
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/24/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/24/2022
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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