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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206137
Report Date: 09/29/2022
Date Signed: 09/29/2022 03:50:44 PM


Document Has Been Signed on 09/29/2022 03:50 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:OUSD - HARRIET TUBMANFACILITY NUMBER:
010206137
ADMINISTRATOR:REED, VONZELEFACILITY TYPE:
850
ADDRESS:800-33RD STREETTELEPHONE:
(510) 654-7890
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY:72CENSUS: 25DATE:
09/29/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lawrence GotancoTIME COMPLETED:
04:05 PM
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On Thursday, September 29, 2022 at 12:30 PM, Licensing Program Analyst (LPA) Caroline Colson met with Lawrence Gotanco, Principal, for an unannounced case management inspection. There are 25 preschool children present and 7 staff members including principal. Documentation was obtained. The unusual incident that was reported to our office is for the OUSD Special Education Department and not for the licensed facility.

There were no deficiencies cited during this inspection.

Exit interview was conducted. Appeal rights were given and discussed. A site visit notice was posted.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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