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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010209844
Report Date: 06/28/2022
Date Signed: 06/28/2022 04:01:09 PM


Document Has Been Signed on 06/28/2022 04:01 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:BLUESKIES FOR CHILDREN - ELLEN SHERWOOD NURS SCHFACILITY NUMBER:
010209844
ADMINISTRATOR:GARCIA, KAIYA SHEPARDFACILITY TYPE:
850
ADDRESS:3021 BROOKDALE AVENUETELEPHONE:
(510) 261-1077
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:54CENSUS: 19DATE:
06/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Christa EdwardsTIME COMPLETED:
04:00 PM
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On 06/28/2022 at 2:45 PM, Licensing Program Analysts (LPAs) Christina Watts and Morgan Pringle conducted an unannounced case management inspection at Blueskies for Children-Ellen Sherwood Nursery School. LPAs met Director, Christa Edwards and explained the purpose of today's inspection.

At the time of inspection, 19 children were in care and 52 children are enrolled.

Facility was cited an Type A citation on June 7, 2022 for violation of personal rights. A plan of correction was received during today's inspection.

Deficiency has been cleared as of June 28, 2022.

Exit interview was conducted and report was reviewed with the Director, Christa Edwards. A Notice of Site Visit was given and must remain posted for 30 consecutive days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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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