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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408917
Report Date: 05/05/2022
Date Signed: 05/05/2022 10:53:29 AM

Document Has Been Signed on 05/05/2022 10:53 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:OLIVINA EDUCATIONFACILITY NUMBER:
073408917
ADMINISTRATOR:HONG, LIFACILITY TYPE:
850
ADDRESS:1265 DAINTY AVENUETELEPHONE:
(925) 434-2939
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Deborah JoyceTIME COMPLETED:
11:15 AM
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On 05/05/2022, Licensing Program Analysts (LPAs) Melissa Guirit and Melissa Domantay conducted an announced change of ownership inspection that resulted in a case management inspection. Present for today's inspection was qualified Director, Deborah Joyce. A tour of the facility was conducted with Director to ensure the Health and Safety of children. LPAs reminded Director that the facility must be fully set up before being able to license, including the rooms used by children, outdoor play yard, and functioning toilets. Director agreed and stated that once everything is set up, a virtual inspection will take place before LPAs come out to measure the facility.

No deficiencies cited during today's inspection. A copy of this report and appeal rights provided to Director, Deborah Joyce.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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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