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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206131
Report Date: 08/30/2019
Date Signed: 08/30/2019 02:04:46 PM

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:OUSD - HINTIL KUU CAFACILITY NUMBER:
010206131
ADMINISTRATOR:JEFF, DOLORESFACILITY TYPE:
850
ADDRESS:11850 CAMPUS DRIVETELEPHONE:
(510) 879-0840
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:42CENSUS: 15DATE:
08/30/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Dolores JeffTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced case management site inspection for this facility at 1315. LPA met with site supervisor, Dolores Jeff. This program is currently operating out of one room, the preschool room, with 15 preschool age children present. While present at this site, LPA spoke with Site Principal, Caroline Jones, regarding the status of the pending change of capacity application for this facility. Site Principal confirmed that this program is currently operating out of one classroom and is expected to continue this for the immediate future. The application for decrease of capacity to 16 children in care will be processed as submitted.

There were no deficiencies cited during this inspection. A notice of site visit was provided and a copy of this report is to remain in the facility records and available for public review for a period of three years.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019
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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