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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206131
Report Date: 04/27/2022
Date Signed: 04/27/2022 03:06:52 PM


Document Has Been Signed on 04/27/2022 03:06 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:OUSD - HINTIL KUU CAFACILITY NUMBER:
010206131
ADMINISTRATOR:JONES, CAROLINEFACILITY TYPE:
850
ADDRESS:11850 CAMPUS DRIVETELEPHONE:
(510) 879-0840
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:42CENSUS: 12DATE:
04/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Dolores JeffTIME COMPLETED:
03:15 PM
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On 4/27/2022, at 1:15PM, Licensing Program Analyst (LPA) Catherine Fernandes met with Teacher Dolores Jeff for an unannounced required annual inspection. The center will be inspected to conduct a health and safety check. Present during the inspection were 12 preschool aged children and one additional staff member. The teacher/ child ratio was being met today. This center operates Monday through Friday 8:00AM to 3:00 PM.

Due to insufficient time the inspection will be continued.


Exit interview conducted with Jeff
Appeal Rights and Report provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
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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