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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206146
Report Date: 07/17/2023
Date Signed: 07/17/2023 10:51:53 AM


Document Has Been Signed on 07/17/2023 10:51 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:OUSD - MANZANITAFACILITY NUMBER:
010206146
ADMINISTRATOR:BIRDIE WINROWFACILITY TYPE:
850
ADDRESS:2618 GRANDE VISTA AVENUETELEPHONE:
(510) 879-0829
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:79CENSUS: 12DATE:
07/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Roxanne HancockTIME COMPLETED:
11:30 AM
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On 07/17/2023 at 9:30AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management inspection to follow up on a self-reported unusual incident. LPA met with lead teacher, Roxanne Hancock, to explain the purpose of the visit. LPA A. Curry toured the facility, retrieved documentation, and conducted interviews with staff and children. No deficiencies are being cited.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023
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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